Pediatrics Flashcards
Skin to skin contact is important for baby because why?
- Temperature (d/t surface to volume - rapid heat loss)
- Immune function - less infection
- Psychological Benefits
* Surface to volume ratio in newborn conducive to rapid heat and fluid losses
How long to breast feed?
breast feeding for the first 6 months of life and then continue another 6 months
Breast feeding reduces what kind of infections?
- Lower incidence of infections:
- including otitis media,
- lung infection,
- pneumonia
- sepsis
- meningitis
True or False:
Human milk contains bacterial and viral antibodies (secretory IgA) and macrophages?
True
Lactoferrin is a protein found in breast milk that inhibits growth of what?
E. coli.
True or False:
ALL states do newborn screening test for galactosemia / phenylketonuria at birth?
False:
hypothyroidism & phenylketonuria (can cause development, cognitive )
True or False:
MOST states check for
1. galactosemia (sugar - brain involvement)
2. sickle cell disease (s hemoglobin)
TRUE….and ALL states check for…
- hypothyroidism
- phenylketonuria
FTT (Failure To Thrive)
FTT is suspected when growth is below the 3rd or 5th percentile
Poor growth without a medical etiology. Often related to poverty or poor caregiver-child interaction.
Nonorganic FTT
Poor growth caused by an underlying medical condition, such as inflammatory bowel disease, renal disease, or congenital heart conditions.
Organic FTT
CBC (Complete Blood Count) used for FTT why?
To check for infection.
Laboratory evaluation is usually limited to a complete blood count (CBC), a lead level, urinalysis and culture and a serum electrolyte level including calcium, blood urea nitrogen / [BUN] and creatinine - to check function of kidney.
A TB skin test and HIV virus testing may also be indicated.
Healthy infant versus FTT?
Healthy infants in their first year of life require approx. 120 kcal/kg/d of nutrition, and 100 kcal/kg/d thereafter.
- versus -
FTT children require and additional 50%-100% to ensure adequate catch-up growth.
True or False?
Solid foods are offered before liquids, children are not force fed
True
Hearing is measured at birth why?
Check for Otitis Media- could lead to hearing loss. Could cause rupture. In an adult pain will go away with hearing loss.
True or False?
The two classic infectious etiologies for acquired hearing loss in children are meningitis and recurrent otitis media?
True
Premature babies are at risk for what condition?
Anemia
Routine screening for anemia is done primarily when there are risk factors for iron deficiency during infancy (i.e., prematurity, low birth weight, and poor dietary intake).
Baby formulas contain iron supplementation
True or False:
Menstruating adolescent females are also at risk for iron deficiency anemia.
True
A risk factor for neurologic damage including retardation, learning disabilities and hyperactivity.
Lead - Routine screening is controversial, usually only done now in high risk individuals (i.e., child is a paint chip eater, or lives near an old battery factory).
First dentist appointment is by ? years of age.
2-3 years
What vitamin can newborns likely be deficient in?
Mostly supplementation is needed only if there is inadequate maternal Vit. D intake.
Reduced sunlight exposure, and/or breast feeding beyond the first 6 months of life are risk factors warranting Vit. D supplementation.
Why are vaccinations good?
Vaccination programs have eliminated small pox, and reduced the incidence of diseases (Haemophilus influenza type B [Hib], polio, measles, tetanus, rubella, and diphtheria).
What are true contraindications to vaccinations?
- Immediate hypersensitivity reactions to a vaccine, vaccine component or preservative agent.
- Egg hypersensitivity is contraindication to influenza and yellow fever vaccines
In general, live virus vaccines are not given to pregnant women and severely immunocompromised patients, but they are given to a child living in the home with a pregnant woman.
Serum follicle stimulating hormone (FSH) and lutenizing hormone (LH) levels as well as bone age x-rays are helpful first steps in the diagnostic workup checks for what condition?
Precocious Puberty
Precocious Puberty is a problem with what gland?
Pituitary
Precocious Puberty might be the problem if there are early signs of puberty at what ages? 1. girls by age ___?
2. boys by age ___?
- Girls age 8
2. Boys age 9
No signs of puberty: girls by age 13, in boys by age 14?
- Delayed Puberty
- Precocious Puberty
Delayed
True or False: Stage I is adult, Stage V is pre-adolescent.
Stage I is pre-adolesecent, Stage V is adult.
True (Central) Precocious Puberty?
- Gonadotropin-dependent.
- Gonadotropin-independent.
- Gonadotropin-dependent.
- Delayed Puberty or
- Precocious Pseudopuberty?
Gonadotropin-independent.
No hypothalamic-pituitary-gonadal activation.
Hormones at root of changes are usually either exogenous (birth control pills, estrogen creams), or
Precocious Pseudopuberty
Average age of puberty?
- Males?
- Females?
(Stage I changes)
- 11.5 in males (testicles)
- 10.5 y/o in females (breast development)
The growth chart checks for what percentile?
abnormally high excess (growth = pituitary) or low (failure to thrive, organic or nonorganic)
What do they test for in newborn screenings?
- developmental, genetic, and metabolic disorders
- blood tests, screening for hearing loss
- blood tests critical congenital heart disease (CCHD) is recommended for all newborns.
Low birth weight…absorption versus malnutrition… they check what?
- Dietary history
can offer important clues – follow up may require a two week daily food diary to establish a baseline of nutrition. - Type of milk,
(breast or bottle), frequency and quality of feeding, vomiting and stooling are recorded. - Amount of and type of juices and solid foods are noted for older children.
In every pediatric care visit they always check what four things?
- Blood pressure
- Height
- Weight
- Development/Behavioral Assessment
What do they ‘measure’ to check proper development of infant?
- head (first 2 yrs of life)
- length
- weight
Q: What is the most likely diagnosis?
A mother brings her 12 month old child, a new patient to your clinic for a well-child visit. The infant appears to be small for her age. Her weight is below the 5th percentile on standard growth curves (50th percentile for an 8 month old), her length is at the 25th percentile, and her head circumference is at the 50th percentile. Her vital signs and physical exam are otherwise normal.
Failure To Thrive (below 5th or 6th percentile)
What might be some causes of non-organic (Psychosocial) FTT?
- Poverty
- Poor caregiver - child relationship
- Type of milk, (breast or bottle),
- frequency and quality of feeding
- vomiting and stooling are recorded
- Type of milk, (breast or bottle),
- frequency and quality of feeding
- vomiting and stooling are recorded
True or false all cases of suspected child maltreatment must be reported to Child Protective Services?
True
A 4 year old child complains of ear pain. His temperature is 102.1 F, and he has had a cold for several days.
He has been eating well and his activity level has been essentially normal.
What is the most likely diagnosis?
Otitis media (middle only) Usually starts with URI (Upper Respiratory Infection)
Otoscope checks what?
Ear
Infection of outer ear is called?
Otitis External
Baby has fever, ear pain and ear drum is clear what is next step?
Watching and waiting
Baby has fever, ear pain and ear drum is red what is next step?
Anti-biotics
True or False: Ear pain can cause GI problems?
True
What is tympanic membrane?
Ear drum
Pneumatic otoscopi is what?
Use air flow to check if ear drum is working…pneumatic is like lung/air
Order or inner ear landmarks Stapes / Malleus / Incus??
Malleus / Incus / Stapes
Augmentum is used when?
When patient does not respond to amoxycillin alone. (Clavalunate is added to augmentum)
What is most common form of bacteria?
Streptococcus pneumoniae
If you are suspicious of pneumonia what do you do first?
X-ray
What is the antibiotic that they prescribe for pneumonia?
Azithromycin
What is the antibiotic that they prescribe for ear infection?
Amoxycillin
What is tx for Herpes Simplex Virus (HSV)?
Acyclovir
Pulse oximetry: non-invasive estimation of arterial oxyhemoglobin concentration (SaO2) is a test for what condition?
Pneumonia
What disease? Symptoms range from traditional cough, bloody sputum, fever and weight loss to subtle or non-specific findings. The purified protein derivative (PPD) test is defined by induration diameter
Tuberculosis
Chest x-ray for what two conditions?
TB and Pneumonia
Is tx of TB simple or complex?
Complex. May change medications several times.
Is there inflammation in asthma?
Yes
Is there narrowing of airways in asthma?
Yes, do to spasm
Is there increased mucus production in asthma?
Yes, there can be…narrowing airways even more
Is asthma an obstructive pulmonary disease?
Yes. Obstructive Pulmonary Disease (not COPD)
Childhood asthma is diagnosed before what age?
Age 12
FEV1 diagnosis is used for what condition typically?
Forced Expiratory Volume for Asthma
What is first and most important step in treating asthma?
Remove triggers
What do bronchodilators do?
Reduce constriction….they relax muscles.
Is tachycardia distress or failure?
Distress. Know which fall into which categories (Failure and Distress)
IgE indicates what is happening?
Inflammation
What are typical meds for asthma?
ie: Albuterol
nebulizer does what?
Penetrates deeper
Leyukotrine modifiers are used for what condition?
Asthma (inflammation and smooth muscle)
