Pediatrics Flashcards
Which immunization is universally recommended for all children at age 1 year (12-23 mos)
Hepatitis A
What is the hepatitis B schedule
3 dose series
0, 1-2 mos, 6 months after first
*must delay blood donation for 28 days
How do you treat pertussis
Macrolides
Which one do you get before 7 years of age
DTap
Which one do you get after 7 years
TDap
Which immunization should a pregnant woman get in the third trimester
TDap
What booster immunization does an 11-12 year old get
TDap
What immunization is recommended for healthcare workers And patients 65 years or older
TDap
Which immunization git rid of epiglottis
Hib
Which immunization creates a rash
MMR
Which vaccine is important for infants due to tiny airways
Pneumococcal vaccine
Is polio a live or dead virus
Dead
Ok to give in immunocompromised patient
Which vaccine is contraindicated in allergies to neomycin, streptomycin, or polymixin B
Polio IPV
Live attenuated vaccines equal
Fever & rash
Favorable response
What are to live attenuated vaccine examples
MMR and varicella
At what age should I live attenuated vaccine be given
MMR and Varicella
After the age of one years old
Which immunizations should not be given if a patient is allergic to neomycin or gelatin
MMR and varicella
At what age should the meningococcal conjugate vaccine be given (MCV4)
Age 11 to 12 years old
W what is a common reaction with the HPV, MC4, and TDap vaccines
Syncope
A vaccine should be given in how many days prior to the scheduled time to be considered a valid dose
4 days
In how many days given prior to the scheduled time would in a ministration be considered invalid and should be repeated
Five days
What type of medication is contra indicated in receiving a varicella or MMR live attenuated vaccination
Oral antivirals
What is the CDC’s recommendation for length of time to monitor a child after receiving an immunization
15 minutes
Which immunization is administered in order to protect the patient from pertussis
TDap
A 12 month old received the MMR immunization three weeks ago. When can the varicella vaccination be given
in 1 week
You must wait 4 weeks in between live attenuated vaccinations
What are the core symptoms of ADHD
Hyperactivity, impulsivity, and inattention
What are the names of the rating scales for ADHD assessment
Child behavior checklist, Connors rating scales, Vanderbilt ADHD rating scales
The most commonly prescribed and tested medications for a ADHD are schedule
II
Highly addictive and often abused. Requires urine drug screen
What drug is used in the treatment of childhood asthma
Leukotriene receptor agonist
Ex. Singular
Administered via nebulizer
The most common pathogen in pneumonia for children six months to five years old is
Viral
When a child has bacterial pneumonia the most common pathogen is
Streptococcus pneumoniae
DRSP
What is the most sensitive sign of pneumonia in children and older adults who are not running a fever
Increased respirations
What is the gold standard of diagnostic studies for pneumonia
Chest x-ray
Besides a chest x-ray what other diagnostic studies should be given to a child with pneumonia
CBC with differential
WBC >15000 if bacterial
What antibiotic choice is first line treatment for pediatric patients who have bacterial pneumonia
Amoxicillin 90 mg per kilogram per day with drug resistant strep pneumo use high dose amoxicillin
If a pediatric patient with bacterial pneumonia is allergic to penicillin, what type of medication should you prescribe
Either a macrolide, or clindamycin
What type of infection is bronchiolitis
Viral
How is bronchiolitis treated
Supportive care
How is croup managed
Single dose of oral dexamethasone
On what basis should a child be admitted with croup symptoms
Retractions, stridor, respirations >=20, and history of asthma
What test is used to diagnose cystic fibrosis
Sweat test
What is cystic fibrosis
The inability to transport sodium and chloride across epithelial membranes
What symptoms might be present in a child with suspected cystic fibrosis
Recurrent pulmonary infections
Re-current upper respiratory infections are usually due to
Allergies
What does lead toxicity masquerade as
Iron deficiency anemia
What are the most common symptoms associated with lead toxicity
Stomach ache, constipation
If you see pan cytopenia on a CBC what is the most likely diagnosis
Leukemia
What type of cancer is failure of the bone marrow
Leukemia
What are the most common presenting signs of leukemia
Fever in the evening, bleeding, long bone pain in legs, lymphadenopathy
At what size are nodes considered to be enlarged
10 mm
Should you give ibuprofen to a child under 6 mos of age
No
At what age should the time out method of discipline be initiated
18 to 24 months old
How long should a child remain in time out
One minute for each year of life
In a 3 1/2 year-old child what percentage of speech should be intelligible by people who are not in daily contact with the child
Nearly 100%
At what age does the child have separation anxiety
Age 7 to 8 months
Went to the lower central incisor teeth start to erupt
6-10 mos
When do the upper central incisor teeth erupt
At 8 to 12 months
At what age does a baby respond to their own name and sit up without support
6 to 8 months old
At what age does a baby reach for a toy with one hand and recognize familiar people and objects at a distance
4 to 6 months old
At what age does a baby babble mama baba and transfer objects hand to hand without difficulty.
6 to 8 months
At what age does a baby vocalize AH and OH sounds, and is able to lift had briefly when positioned on the tummy and turn it from side to side.
6 to 8 weeks old
For a baby that was born prematurely, the adjusted age calculation should be used to assess their development until age
24 months
In examining a healthy two month old baby boy the foreskin cannot be retracted it is considered that
In most instances, the foreskin is not easily retractable until the child is about three years old
When do symptoms of pyloric stenosis typically begin to emerge
4 to 6 weeks
Olive shaped mass that is palpated on a baby’s stomach after projectile vomiting
Pyloric stenosis
A four week old has suspected pyloric stenosis. What imaging study is most commonly used to diagnose this?
Ultrasound
What symptom might indicate GERD instead of GER in an infant?
Irritability during reflux episode
If a baby is having GER symptoms should the mother continue to breast-feed or not?
Yes she should continue to breast-feed, and please baby in supine position to sleep
This pediatric condition is due to intestinal obstruction, and the child will cry and pull their legs up to their chest. The age of onset is usually 3 to 11 months old. In order to diagnose the distance condition a KUB, abdominal ultrasound would be done. This is a surgical emergency.
Intussusception
What pediatric condition causes currant jelly stools
Interssusception
This pediatric condition consist of involuntary soiling of stool in a child four years old or older. It is more common in males, and the underlying problem is constipation.
Encopresis
How do you treat encopresis?
Laxatives for initial cleansing , then daily until normal stools . encourage child to sit on the toilet for five minutes to to three times daily after meals to establish normal bowel movements . the goal is one soft store per day .
What is the preferred means of oral rehydration for a child who has diarrhea?
Commercially prepared electrolyte solution such as Pedialyte
When should a patient with cryptorchidism be referred to urology?
6 mos. of age
A nine month old has hydrocele. What advice should be given to the caregiver?
It should resolve by 12 months of age. If not then the patient needs a referral to urology
A one-year-old has persistent hydrocele. What might be an underlying cause?
Hernia
A five-year-old has nocturnal enuresis. How should this be managed?
Allow the child and caregiver to decide when treatment should be initiated.
How do you treat a pediatric urinary tract infection
Collect a specimen and then prescribe a can a third generation cephalosporin such as Cefixime, cefdinir, and ceftibuten
What is the imaging of choice for pediatric urinary tract infection for all and friends ages 2 to 24 months of age with a fever
Renal and bladder ultrasound
An eight-year-old male has a sore throat and a tongue with a prominent, erythematous papillae. What should be part of the differential diagnosis
Kawasaki Disease
Strept throat
Strawberry tongue is associated with
Kawasaki disease
Acute generalized systemic vasculitis of the medium size vassals around the heart
Kawasaki disease
What pediatric condition produces conjunctivitis without exudate, macular rash, inflammation of the lips and oral cavity, cervical lymphadenopathy, and EDEMA OF THE HANDS AND FEET
Kawasaki disease
What diagnostic tests are given for a Kawasaki disease?
CBC, ESR, CRP, ALT/AST, UA, throat culture
Echocardiogram
How is Kawasaki disease treated?
Patient is referred to a pediatric cardiology for IV immune globulin and aspirin. Aspirin daily for two months.
What condition is always a result of a pole injury or twisting of the arm
Nursemaids elbow
What condition leads to knee pain in an adolescent
Osgood Schlatter Disease
At what age does Osgood Schlatter disease occur most often
15 years old
What term describes the cause of pain in a patient who has Osgood Schlatter disease?
Osteochondritis
When does Osgood Schlatter disease occur?
After a growth spurt
How do you manage a patient with Osgood Schlatter disease?
Continuation of activity as pain tolerates, ice, analgesics for 3 to 4 days, kneepad.
When a pediatric patient presents with hip pain what type of x-rays do you get
AP, and frog leg views
What pediatric condition is osteonecrosis of the capital femoral head due to lack of blood supply
Legg-Calve-Perthes disease
What is the Ann office diagnostic tool for Leggs-calves-Perthes disease
Trendelenburg test
What to pediatric hip conditions need x-rays
Slipped Capital Femoral Epiphysis (SCFE) and Leggs-Calves-Perthes Disease
What pediatric hip condition starts with a history of upper respiratory infection 7 to 14 days prior.
Transient Synovitis of the hip
No xrays
Subsides on its own
Treat symptomatically
Coxsackie A virus is associated with
Herpangina
Coxsackievirus A16 is associated with
Hand foot mouth
Which viral exanthem is a maculopapular brick red rash, that starts on the head and neck and spreads to the trunk and extremities
Measles (Rubeola)
Which viral exanthem creates a slapped cheek rash, Lacy, macular rash
Fifth Disease (Erythema infectiosum)
Which viral exanthem creates a high fever for 2 to 4 days, then abrupt cessation of fever with the appearance of maculopapular rash but not on the face
Rose Ola (Exanthem subitum)
When can a child with roseola go back to school
24 hours after the patient is fever free
When can a patient with chickenpox go back to school
24 hours fever free and after all vesicles have crusted over
Which viral exanthem is an exotoxin rash secondary to group A strep infection, sandpaper like rash that ultimately desquamates
Scarlet fever
What disease manifests as vesicles that rupture and produce painful alterations on the soft palate in the mouth
Herpangina
Do all viral exanthem rashes blanche
Yes
Does petechiae and purpura Blanche
No
A three-year old is diagnosed with fifth disease. Her mother is pregnant in the first trimester and has had significant exposure to the sick child. If her mother is not immune, what is the risk of the fetus?
Intrauterine fetal death
At what age is roseola usually diagnosed
7 to 13 months
Koplik spots are associated with
Measles
Resembles grains of sand of the oral mucosa and precedes rash
Cough, runny nose, and conjunctivitis are findings of
Measles
A bulging and cloudy TM is associated with
acute otitis media
How do you treat otitis media for a child that is under six months of age
Antibiotics
Amoxicillin
How do you treat otitis media in a child six months to two years of age
Antibiotics if severe, observe if not severe
How do you treat otitis media in a child that is greater than two years of age
Antibiotics if severely ill otherwise observation only
A two-year-old is diagnosed with otitis media and an antibiotic is prescribed. When should her fever resolve after receiving the antibiotic?
48 to 72 hours
How do you treat a patient who has had recent antibiotic exposure for otitis media
Amoxicillin clavulanate or Augmentin
If a patient is allergic to pcn, what should be prescribed for otitis media?
2nd or 3rd generation cephalosporins
Pyloric stenosis usually occurs in
The first born male
A mild fever may occur after which vaccination
Pneumococcal conjugate 13 valent vaccine
Prevnar
PCV13
When is screening for autism recommended
18 to 24 months
What tanner stage is pre-puberty
Stage one
What tanner stage has breast butts and the popular elevated, Downey pigmented pubic hair along the labia majora. Testes enlarge, scrotal skin reddening with change in texture, sparse growth of long slightly pigmented pubic hair at base of penis.
Stage two
What Tanner stage is consistent with breast mound enlargements, darker, courser, curly pubic hair on mons, labia majora, onset of growth spurt. Increase in penile length but minimal change in width, sometimes called the pencil penis stage. Further scrotal enlargement, pubic hair darker, courser, covers great area, onset of growth spurt
Stage three
What tanner stage is consistent with having an areola and papilla elevated to form a second mound above level of rest of breast, adult type pubic hair with no spread to medial surface of thighs, menarche. Increase in penile length and width with development of glans, further darkening of scrotal skin, adult type pubic hair with no spread to medial surface of thighs.
Stage 4
What tanner stage is consistent with the recession of areola to mound of breast, extension of pubic hair to medial thigh. Full adult genitalia, adult type pubic hair with spread to medial surface of thighs, possibly abdomen
Stage five
What Tanner stage can gynecomastia be found
Tanner stage III
Symptoms of this condition include macroorchidism, large body habitus, history of learning differences.
Fragile X syndrome
What is the most common known cause of autism in either gender, occurring in all racial and ethnic groups.
Fragile X syndrome
Which condition only affects males and has a low testicular volume, hip and breast enlargement, and infertility.
Klinefelter syndrome
What syndrome is characterized by a short stature, usually evident by age 5, white, webbed neck, Brad, shield shaped chest, absent menses, infertility.
Turner syndrome
What medication is indicated for cystic acne that does not respond to other therapies such as oral antibiotics and topical retinoids
Accutane
Anabolic steroid use is consistent with which type of acne
Cystic acne
In the USA which of the following is the most common cause of adolescent death
Accidental injury
Do the majority of states require either a parental consent or notification for teenagers younger than 18 to have a pregnancy termination
Yes
If a child with a BMI of 40 presents with a lipid profile that reveals low HDL, elevated triglycerides, and an acceptable A1c what is the best treatment option
Weight loss
A full-time newborn is diagnosed with hyperbilirubinemia. When would his Billirubin be expected to peak
3 to 4 days
At what age should initial blood pressure screening take place
Three years
Which reflex would not be expected in a one month old
Parachute
Cafe au lait spots are associated with
Neurofibromatosis and Von Recklinghausens Disease
For patients with down syndrome what are they at risk for with high-risk sports
Contact sports such as football, soccer, trampoline, or gymnastics can be a risk of spinal cord injury. Especially after the age of six years. These patients are also at risk for early onset of Alzheimer’s disease
Microcephaly with shortened palebral fissures (narrow eyes) with epicanthal folds and a flat nasal bridge. There is a thin upper lip with no vertical groove above upper lip (smooth philtrum). Ears are underdeveloped. Can range from severe Disease with mental retardation to mild developmental defects that may not be obvious until adolescence (ADD).
Fetal alcohol syndrome
Any neonates with acute conjunctivitis presenting within 30 days or less from birth should be tested for
Chlamydia, gonorrhea, herpes Symplex, and bacterial infection. Order GC culture (Thayer-Martin), heroes simplex culture, and chlamydial PCR with Gram stain of eye exudate. Hospitalize and treat with high dose IV or IM ceftriaxone. Preferred prophylaxis is with topical 0.5% erythromycin ointment (1cm ribbon per eye). Test and treat mother and sexual partner for sexually transmitted diseases.
Symptoms of this will show within 4 to 10 days after birth. Eyelids become edematous and red with Profuse watery discharge initially that later becomes purulent. When obtaining a sample, collect not only the exudate, but also conjunctival cells as well. Treat with systemic antibiotics such as azithromycin IM or oral erythromycin QID for 14 days. Treatment only 80% effective. Many need second course. Use only systemic antibiotics. Prophylaxis is with topical 0.5% erythromycin or tetracycline ointment 1m ribbon per eye. Reportable Disease. Test and treat mother and sexual partner for STDs.
Chlamydial Opthalmia Neonatorum (trachoma)
In infants with opthalmia neonatorum, what else needs to be ruled out
Chlamydial pneumonia. Obtain nasopharyngeal culture for chlamydia. Infant will have frequent cough with by bibasilar rails, tachypnea, hyperinflation, and diffused infiltrates on chest x-ray. Treated with erythromycin QID times two weeks. Daily follow up as this is a reported disease
What place is an infant at a higher risk for sudden infant death syndrome
Prematurity, low birth weight, maternal smoking and or drug use, and poverty. Cause is unknown. Theories range from central nervous system abnormalities, cardiac arrhythmias, suffocation from soft, thick bedding, and so on. To decrease risk, position infants 👶🏻 on their back or supine only. Avoid the side lying and prone position. Avoid overheating infant and use of thick quilts, soft beds, pillows, And so on.
Weight loss of up to 7% of birth weight should be regained by how many days
10 to 14 days
Small pustules that are whitish to yellow color that are 1 to 3 mm in size and surrounded by a red base. Erupts during the second to the third day of life. Located on the face, chest, back, and extremities. Last from 1 to 2 weeks and resolves spontaneously.
Erythema Toxicum Neonatorum
Tufts of hair overlying spinal column usually at lumbosacral area. Maybe a sign of spina bifida occulta. Order an ultrasound of the lesion to rule out a occult spina bifida.
Faun Tail Nevus
Flat, light brown to dark brown spots greater than 5 mm. If six or more spots larger than 5 mm in diameter are seen rule out Nuro fibromatosis or von Recklinghausen’s disease which is a neurological disorder marked by seizures, learning disorders. Referred to pediatric neurologist if the spots me the same criteria to rule out neurofibromatosis
Cafe au lait spots
