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Review > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

FTT criteria

A

-weight for age <3rd to 5th percentile

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2
Q

Most common chromosomal disorder in US

A

DS

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3
Q

DS presentation

A
  • flat face
  • upward slanting eyes: palpebral fissures
  • low-set ears
  • macroglossia
  • short neck
  • broad hands with transverse palmar crease (simian crease)
  • newborns with hypotonia
  • poor reflexes
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4
Q

What should children with DS avoid using before age 6

A

trampoline

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5
Q

FAS presentation

A
  • microcephaly
  • shortened palpebral fissures
  • epicanthal folds
  • flat nasal bridge
  • thin upper lip with smooth philtrum
  • ears underdeveloped
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6
Q

When is surgical correction needed for cryptochoridism

A

within first year of life it not spontaneously descending

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7
Q

Neonate presenting with acute conjunctivitis within 30 days or less from birth, concerned about what

A
  • chlamydia
  • gonorrhea
  • herpes simplex
  • bacterial infection
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8
Q

Treatment for neonate with gonococcal ophthalmia neonatorum

A

ED for IV abx

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9
Q

Trachoma

A

chlamydial ophthalmia neonatorum

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10
Q

What else to rule out if neonate presents with trachoma

A

-chlamydial pneumonia

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11
Q

Risks for SIDS

A
  • prematurity
  • LBW
  • maternal smoking and/or drug use
  • poverty
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12
Q

Expected newborn weight loss

A
  • formula fed: up to 5%
  • breast fed: 7-10 %
  • loss within 5-7 days
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13
Q

When should neonatal weight loss be regained

A

-within 10-14 days

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14
Q

Signs of severe dehydration in neonates

A

> 10% weight loss

  • tachycardic
  • tachypneic
  • parched mucous membranes
  • anterior fontanelle sunken
  • tenting
  • cool skin
  • acrocyanosis
  • anuria
  • change in LOC
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15
Q

Mongolian spot

A
  • present in almost all Asians
  • blue to black colored patches or stains
  • most commonly on lumbosacral area
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16
Q

what age do Mongolian spots typically fade

A

-by 2-3 years

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17
Q

MIlia, Milaria, or Prickly Heat

A
  • papules on forehead, cheeks, nose
  • retention of sebaceous material and keratin
  • resolves spontaneously
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18
Q

Erythema toxicum neonatorum

A
  • small pustules surround by red base
  • erupts during 2nd-3rd day of life
  • lasts 1-2 weeks
  • resolves spontaneously
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19
Q

Seborrheic dermatitis

A
  • cradle cap
  • thick scaling on scalp
  • treat with soaking with vegetable oil or mineral oil
  • shampoo and gently scrub
  • prevention with frequent shampooing with mild baby shampoo
  • resolves in a few months
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20
Q

Faun Tail Nevus

A

-tufts of hair overlying spinal column usually at lumbosacral area

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21
Q

What can faun tail nevus indicate

A

-possible NTD

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22
Q

Plan for faun tail nevus

A
  • neuro exam

- US of lesion to r/o occult spina bifida

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23
Q

Cafe au lait spots

A
  • flat spots
  • > 6 or larger than 5 mm –> r/o neurofibromatosis or von Recklinghausen’s disease
  • refer to pediatric neuro if it fits this criteria
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24
Q

Port wine stain

A
  • Nevus Flammeus
  • pink to red, flat, stain like lesions on upper and lower eyelids of branches of CN V
  • blanches
  • Large lesions on half of face may be sign of trigeminal nerve involvement
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25
Q

Port wine stain treatment

A
  • does not regress
  • grows with child
  • treat with pulse-dye laser therapy
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26
Q

Hemangioma

A
  • strawberry hemangioma
  • rapid vascular lesions 0.5-4 cm
  • bright red in color
  • soft to palpation
  • majority spontaneously resolve
  • PDL therapy
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27
Q

Newborn vision: far or near sighted

A
  • Myopia (near sighted)

- 20/200

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28
Q

T/F: newborns may appear with crossed eyes and is a normal finding

A
  • True

- unless one eye is consistently turned in or out —> ophto

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29
Q

T/F: newborns shed tears

A

-False: lacrimal ducts not fully mature at birth

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30
Q

Horizontal strabismus may be

A

Estropia
inward turning of eyes
Extropia
outward turning of eyes

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31
Q

Vertical strabismus may be

A

Hypertropia
one eye higher than the other
Hypotropia
one eye lower than the other

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32
Q

What can uncorrected strabismus lead to

A

permanent visual loss

abnormal vision

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33
Q

What is strabismus

A

misalignment of one eye

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34
Q

Amblyopia

A

lazy eye

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35
Q

Esotropia

A

misalignment of both eyes (cross eyed)

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36
Q

Indications for optho referral

A
  • abnormal red reflex
  • (+) white reflex
  • strabismus
  • greater than two line difference between each eye
  • esodeviation present after 3-4 months
  • corneal light reflex with abnormal
  • shape/appearance of pupils not equal
  • new onset strabismus
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37
Q

Hirschberg test

A

corneal light reflex test

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38
Q

High risk factors for hearing loss

A 
-HEARS
Hyperbilirubinemia
Ear infections that are frequent
Apgar score low
Rubella, CMV, toxoplasmosis
Seizures
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39
Q

Phenylketonuria

A
  • severe mental retardation if not treated
  • inability to metabolize phenylalanine to tyrosine
  • test only performed after being fed for at least 48 hours
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40
Q

Which hemoglobin do normal newborns have

A

F and A

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41
Q

When is screening for anemia done for in infants

A

9-12 months

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42
Q

Lead screening

A
  • high risk screened at 1 to 2 years

- early as 6 months

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43
Q

Dose of vitamin D drops

A

400 IU

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44
Q

Why is cow’s milk avoided

A
  • avoid for 1st year of life
  • causes GI bleeding
  • common cause of IDA in <12 month olds
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45
Q

Failure to pass meconium within 24 hours of birth is concerning for what

A
  • intestinal obstruction

- cystic fibrosis

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46
Q

When can solid foods start

A

4-6 months

  • start with rice cereal
  • introduce one food at a time
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47
Q

First time teeth erupt

A

-6-10 months

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48
Q

First teeth to erupt

A

-lower central incisors

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49
Q

When are all the primary teeth erupted by

A

2.5 years

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50
Q

When do first permanent teeth erupt

A

6 years

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51
Q

Hypospadias

A

-urethral meatus on ventral aspect of penis

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52
Q

Positive Babinski reflex is normal up until

A

2 years old

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53
Q

T/F a strong Moro reflex in a 6 month old is normal

A

False

indicative of brain damage

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54
Q

MMRV vaccine schedule

A

1 at 12 months

2 at 4-6 years

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55
Q

Trivalent flu vaccine given to minimum what age

A

6 months

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56
Q

Quadrivalent flu vaccine given to minimum what age

A

18 years

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57
Q

Is FluMist recommended?

A

No

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58
Q

DTaP schedule

A 
2 months
4 months
6 months
16-18 months
4-6 years
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59
Q

Tdap age requirement

A

at least 7 years

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60
Q

Vaccine Adverse Event Reporting System (VAERS)

A

Report adverse reactions to vaccines

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61
Q

Which vaccines should be completed by age 15-18 months

A
  • Hepatitis B
  • Hib
  • PCV 13
  • Rotavirus
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62
Q

What is the only vaccine given at birth

A

hepatitis B

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63
Q

When is Tdap given as a booster

A

11-12 years

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64
Q

Physiological jaundice spreads how

A

starts on head

progresses downward to chest, abdomen, legs, and soles of feet

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65
Q

When does physiological jaundice start

A

24 hours after birth

clear up in 2-3 weeks

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66
Q

Breast milk jaundice begins when

A

after 7 days
peaks in 2-3 weeks
can take a month to clear

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67
Q

Possible cause of breast milk jaundice

A
  • insufficient breast milk intake

- some women may have a substance that slows down hepatic conjugation of bilirubin

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68
Q

Why does jaundice happen in neonates

A
  • increased breakdown of fetal RBC

- bilirubin exceeding the infants liver capacity to conjugate bilirubin

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69
Q

Treatment plan for pathologic jaundice

A
  • serum fractionated bilirubin level
  • Coombs test
  • CBC
  • retic count
  • peripheral smear
  • treatment usually not needed, keep well hydrated
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70
Q

First line therapy for jaundice

A
  • phototherapy
  • light in blue-spectrum most effective
  • bilirubin excreted in urine
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71
Q

Kernicterus

A
  • complication of high levels of unbound bilirubin

- severe mental retardation, seizures

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72
Q

When does Hgb drop to the lowest level in neonates

A

6-8 weeks

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73
Q

Why does physiological anemia of infancy occur

A

-stimulates kidneys to produce more erythropoietin to prompt BM to make more RBC

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74
Q

Dacryostenosis

A
  • congenital lacrimal duct obstruction

- spontaneously resolves within 6 months

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75
Q

Dacryostenosis presentation

A

persistent tearing and crusting in am

  • reflux of mucoid discharge when lacrimal duct palpated
  • yellow to green is abnormal
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76
Q

Acute dacrocystitis

A
  • redness, warmth, tenderness, and swelling on one or both lacrimal ducts
  • usually due to staph or strep
  • systemic abx for 7-10 days
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77
Q

Acute dacrocystitis lacrimal sac massage

A

-palpate sac and massage down toward mouth

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78
Q

Infant colic rule of 3s

A
  1. crying and irritability >3 hours a day in <3 month old. crying occurs at the same time each day
  2. crying occurs more than 3 days a week
  3. colic resolves by 3-4 months
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79
Q

Up to 30% of neonates with coarctation of the aorta also have what syndrome

A

Turner syndrome

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80
Q

Normal finding for screening coarctation of the aorta

A

-systolic BP higher in legs than arms

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81
Q

Higher risk for developmental dysplasia of hip

A
  • breech births
  • female
  • family history
  • oligohydramnios
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82
Q

Ortolani test

A
  • hold each knee and place middle finger over greater trochanter
  • rotate hips in the frog leg position (abduction, then adduction)
  • (+) click or clunk, or trochanter displacement palpated
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83
Q

Barlow test

A
  • place index and middle finger over greater trochanter
  • push both knees together at midline and downward, then pull upward
  • (+) clunk heard when trochanter slips back into acetabulum
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84
Q

Galeazzi sign

A

-one femur appears shorter when infant is supine

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85
Q

When can a child play patacake and peek a boo

A

9 months

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86
Q

Neuroblastoma most common presentation

A

painful abdomen crossing midline

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87
Q

Neuroblastoma Horner’s syndrome

A
  • miosis
  • ptosis
  • anhidrosis
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88
Q

Initial imaging for Wilm’s tumor

A

abdominal US

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89
Q

Epiglottis organism

A

Haemophilus influenzae

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90
Q

Prophylaxis of close contacts for epiglottitis

A

Rifampin

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91
Q

Is epiglottis a reportable disease

A

yes

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92
Q

Ophthalmoplegia

A

limited movement of eyeball

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93
Q

Preseptal cellulitis

A

-infection of anterior portion of eyelid that does not involve orbit

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94
Q

Greenstick fractures may indicate what

A

child abuse

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95
Q

Top 3 cancers in children

A
  • leukemia
  • bran and CNS tumors
  • neuroblastoma
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96
Q

Clues a child is ready for toilet training

A
  • walking
  • can reach potty chair
  • indicates when diaper is dirty
  • can pull down pants
  • can stay dry for 2 hours
  • interested about toilet
  • can understand basic instruction
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97
Q

When are most children typically ready for toilet training

A

18-24 months

-some not ready until 36 monhs

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98
Q

When will a child usually have complete nighttime bowel control

A

4-5 years

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99
Q

When should a child not dry at night be evaluated

A

if >5 years old

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100
Q

How long should all infants and toddlers ride in a rear-facing car seat

A

2 years

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101
Q

Car safety for toddlers and preschoolers

A

back seat with car seat facing forward

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102
Q

Until what age do children need to be restrained in the back seat

A

12

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103
Q

When do early signs of autism begin to show

A

18 months

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104
Q

Autism screening times

A

18 months to 24 months

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105
Q

Autism signs to watch for

A
  • no pointing, waving, grasping by 12 months
  • no babbling or cooing by 12 months
  • no single words by 16 months
  • no two words by 24 months
  • loss of language or social skills by 24 months
  • no gesturing at 24 months
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106
Q

What population are Wilm’s tumors more common in

A

AA females

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107
Q

At what age is speech understood by strangers

A

3 years

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108
Q

What age is speech understood mostly by family members

109
Q

Kawasaki disease presentation

A
  • high fever
  • enlarged lymph nodes in neck
  • bright red rash
  • conjunctivitis
  • dry cracked lips
  • strawberry tongue
110
Q

Kawasaki disease treatment

A
  • aspirin

- IVIG

111
Q

Kawasaki disease sequelae

A
  • aortic dissection
  • aneurysms of coronary arteries
  • blood clots
  • need f/u with pediatric cardiologist for several years
112
Q

Reye’s syndrome

A
  • history of febrile viral illness and took ASA or salicylate (Pepto Bismol)
  • stage 1: severe vomiting, lethargy, stupor, elevated LFTs
  • stage 2: change in LOC, hyperactive reflexes
  • stage 3-5: confusion, delirious, cerebral edema, coma, seizures, death
113
Q

DS without atlantoaxial stability and sports

A

-low-impact sports and sports not requiring extreme balance

114
Q

Still’s murmur

A
  • benign systolic murmur
  • vibratory or musical quality
  • louder in supine
  • grade 1-2
  • usually resolved by adolescence
115
Q

Can patients with MVP be cleared for sports

A

NO
possible sudden cardiac death
-cardio referral for clearance

116
Q

If a child had documented history of chickenpox, do they still need the chicken pox vaccine

117
Q

If child did not complete hepatitis B series, do they need to repeat series

118
Q

Menactra lowest age to adminsiter

119
Q

Menveo lowest age to adminster

120
Q

When is Menactra or Menveo first dose given

A

11-12 years

121
Q

When is Menactra/Menveo booster typically given

122
Q

Autism treatment plan

A
  • refer to psychiatrist for testing and eval
  • OT, PT, speech therapy
  • some prescribed Risperdal
123
Q

Hand-foot-mouth disease organism

A

coxsackievirus A16

124
Q

When is a patient with hand foot mouth the most contagious

A

-during first week

125
Q

Hand foot mouth treatment

A
  • supportive care

- complete recovery usually in 5-7 days

126
Q

Measles aka

127
Q

Functional constipation aka

A

encoporesis

128
Q

Rome IV criteria for diagnosis functional constipation

A
  • must meet 2 or more at least once per week for at least 1 month
    1: history of withholding stool
    2: history of painful or hard BM
    3: history of large-diameter stools that may obstruct toilet
    4: presence of large fecal mass in rectum
    5: two or fewer defecations in toilet per week
    6: at least one episode of fecal incontinence per week (thin fluid with feces that passes large stool), ask about soiling of underwear
129
Q

Treatment for functional constipation

A
  • laxatives (PEG, Miralax)
  • behavior modifications
  • dietary changes
  • reward system
  • goal for one soft stool a day
  • plain film xray for retained stools
130
Q

All 11-12 year old children should be vaccinated with what single dose

A

quadrivalent meningococcal vaccine (MenACWY)

Menactra or Menveo

131
Q

Which immunizations are needed at age 11-12

A

Tdap
HPV
MCV4

132
Q

What organism is molluscum caused by

133
Q

Youngest age for HPV vaccination

134
Q

acetaminophen is also known as

A

paracetamol

135
Q

Antidote for acetaminophen poisoning

A

-N-acetylcysteine IV

136
Q

Testicular torsion initial diagnostic test

A

doppler US

137
Q

Precocious puberty in females

138
Q

Delayed puberty in females

A

no breast development (Tanner 2) by 12 years

139
Q

Skeletal growth is considered complete within __ years after menarche

140
Q

Mittelschmerz

A

-unilateral midcycle pelvic pain caused by enlarged ovarian follicle

141
Q

Average age of menarche

142
Q

After which tanner stage do girls typically start menses within 1-2 years

143
Q

Dysmenorrhea is caused by

A

elevated prostaglandins

144
Q

Precocious puberty in boys

145
Q

Delayed puberty in boys

A

no testicular/scrotal growth by age 14

146
Q

Spermarche average age

147
Q

Which situations are parental consent not necessary

A
  • contraception
  • treatment of STD
  • diagnosis and management of pregnancy
148
Q

Criteria for emancipated minor

A
  • legally married

- active duty in armed forces

149
Q

Which situations can confidentiality be broken

A
  • gunshot wounds and stab wounds –> must be reported to police
  • child abuse–> authorities
  • SI or SA
  • HI or intent
150
Q

What is a mature minor rule

A
  • unemancipated minor (15-17) with the mental capacity to understand the consequences of a decision
  • Has the right to refuse or to request treatment (even if parents disagree)
  • Each state has its own laws about this
151
Q

What Tanner stage does puberty start

152
Q

Primary amenorrhea

A

no menarche by age 15
with or without development of secondary sexual characteristics
-50% caused by chromosomal disorders

153
Q

Secondary amenorrhea

A
  • no menses for 3 cycles or 6 months if previously had menses
  • most common cause is pregnancy
  • others: ovarian disorders, stress, anorexia, PCOS
154
Q

Secondary amenorrhea associated with exercise and underweight

A

-higher incidence due to caloric deficiency

155
Q

Female athlete triad

A
  • anorexia nervosa/restrictive eating
  • amenorrhea
  • osteoprosis
156
Q

Secondary amenorrhea labs

A
  • pregnancy test
  • serum prolactin
  • serum TSH, FSH, LH
  • if amenorrhea for >6 months, measure bone density
157
Q

Secondary amenorrhea d/t exercise treatment

A
  • educate about caloric intake
  • decrease exercise
  • Calcium and vitamin D 1200-1500 mg and vitamin E 400 IU daily
158
Q

Physiological gynecomastia

A

benign
more common during infancy and adolescence
normal in up to 40% of prepubertal boys
resolve by 6 months to 2 years

159
Q

Gynecomastia findings

A
  • round, rubbery, mobile mound under areola
  • no skin changes
  • if mass if hard or fixed, suspect a secondary cause and refer.
160
Q

Pseudogynecomastia

A
  • bilateral enlarged breasts due to fatty tissue
  • common in obesity
  • no breast bud or disk
161
Q

Scoliosis testing

A

Adam’s Forward Bend Test

162
Q

Cobb angle

A

-degree of spinal curvature

163
Q

Scoliosis curve <20 degrees treatment

A

-observe and monitor for changes

164
Q

Scoliosis curve 20-40 degrees treatment

A
  • bracing

- Milwaukee brace

165
Q

Scoliosis curve >40 degrees

A

-surgical correction with Harington rode

166
Q

What is needed to measure Cobb angle of spine

A

spinal xray PA view

167
Q

Scoliosis treatment

A

refer all patients with scoliosis to a pediatric orthopedic specialist

168
Q

Osgood-Schlatter disease

A
  • common knee pain in young athletes
  • overuse of knee
  • pain, tenderness, and swelling at tibial tuberosity
  • pain improves with rest
  • rule out avulsion fracture or posttrauma with xray
169
Q

Osgood-Schlatter disease treatment

A
  • RICE

- stretching

170
Q

Klinefelter syndrome genetics

A

extra X chromosome

171
Q

Klinefelter presentation

A
  • testicles small and firm with small penis
  • tall with wide hips
  • reduced facial and body hair
  • higher risk of osteoporosis
172
Q

Klinefelter treatment

A

-testosterone replacement and fertility treatment

173
Q

Klinefelter syndrome is due to a ____ leading to a deficiency of ___

A

primary hypogonadism

testosterone

174
Q

Turner’s syndrome genetics

A

partial absence of second X chromosome

175
Q

Turner’s syndrome presentation

A
  • webbed neck
  • congenital lymphedema of hands and feet
  • high-arched palate
  • short fourth metacarpal
  • short stature
  • ovarian failure
  • CVD and renal issues
  • ear malformations
  • amenorrhea
176
Q

Primary amenorrhea labs

A
  • serum pregnancy
  • prolactin (if elevated –> CT of sella turcica; location of pituitary gland)
  • r/o hypogonadism: estrogen, progesterone, DHEA, FSH, TSH
177
Q

Hepatitis A dosing schedule

A

12 months

18 months

178
Q

If mother HBsAg positive, what to do with newborn

A
  • HBIG within 12 hours of birth

- give hep B vaccine

179
Q

Hib vaccination lead to the almost eradication of what disease

A

epiglottitis

180
Q

MMR and MMRV is contraindicated with which allergy

A

neomycin or gelatin

181
Q

For children <8 receiving flu shot for first time, 2nd dose needs to be given by

182
Q

HPV vaccine for 9-14 year old

A

0, 6-12 months later

183
Q

HPV vaccine for >15 year old

A

0, 1-2 months, 6 months

184
Q

CDC recommends monitoring a child for at least ___ after receiving a vaccine

A

15 minutes

185
Q

T1DM labs will show what

A
  • pancreatic antibodies
  • insulin levels
  • C-peptide levels
186
Q

DSM-V criteria for ADHD

A
  • Symptoms present prior to 12 years old
  • Symptoms last >6 months
  • symptoms evident in 2 different settings
187
Q

ADHD treatment first line

A

meds considered first line for patients >6 years old

-methyphenidate, amephetamines

188
Q

What schedule are medications for ADHD

189
Q

Screening tool for autism

A

MCHAT-R/F

18-30 months

190
Q

What age can montelukast be given

A

starting 2 years

191
Q

When can asthma treatment be stepped down

A

-if well controlled at least 3 months

192
Q

Step 2 of child 0-4 with asthma

A
  • low dose ICS

- alt: Singulair, Cromolyn

193
Q

Step 3 of child 0-4 with asthma

A

-medium dose ICS

194
Q

Step 4 of child 0-4 with asthma

A
  • medium dose ICS

- AND either Singulair or LABA

195
Q

Step 5 of child 0-4 with asthma

A
  • high dose ICS

- AND either Singulair or LABA

196
Q

Step 6 of child 0-4 with asthma

A
  • high dose ICS
  • AND either sinulair or LABA
  • AND oral corticosteroid
197
Q

Montelukast (Singular) class

A

Leukotriene Receptor Antagonist

198
Q

Nedocromil class

A

Mast cell stabilizer

199
Q

Alternative medications that can be used for 5-11 year olds with asthma

A
  • LTRA
  • Nedocromil
  • Theophylline
  • Cromolyn
200
Q

Cromolyn class

A

Mast cell stabilizer

201
Q

Which 2 alternative medications can be used with Step 3-6 for 5-11 year olds with asthma

A
  • LTRA

- Theophylline

202
Q

Step 3 of 5-11 year old with asthma

A
  • preferred low dose ICS + LABA, LTRA, or
  • theophylline
  • or med dose ICS
203
Q

Step 4 of 5-11 year old with asthma

A

-medium dose ICS + LABA

204
Q

Step 5 of 5-11 year old with asthma

A

-high dose ICS +LABA

205
Q

Step 6 of 5-11 year old with asthma

A

-High dose ICS + LABA + oral steroid

206
Q

PCV13 plus PCV23 should be given to who

A

high risk children >2 years old

207
Q

PNA management in children

A
  • Amoxicillin 90 mg/kg/day first line (Augmentin, or 3rd gen ceph if recent abx exposure)
  • PCN allergy: macrolide, clindamycin
208
Q

Bronchiolitis treatment

A

-supportive

209
Q

Best steroids to give to children if needed

A

-single dose oral dexamethasone 0.6 mg/kg

210
Q

Fastest onset medication for GFR

A

-nebulized epinephrine

211
Q

Cystic fibrosis patho

A

-abnormal transport of Na and Cl across epithelial membranes

212
Q

Cystic fibrosis testing

A
  • sweat test
  • if positive once, repeat again
  • it positive twice, send to CF clinic
213
Q

Symptom to suspect CF

A

persistent productive cough
weight loss
greasy stools

214
Q

Patients with sickle cell anemia may take daily what

A

-daily PCN for Strep pneumo prophylaxis

215
Q

Lead toxicity presentation

A
  • fatigue
  • GI complaints
  • irritability
216
Q

Leukemia presenting signs

A
  • anorexia
  • hepatosplenomegaly
  • fever
  • bleeding
  • plts <100,000 (thrombocytopenia)
  • lymphadenoapthy
  • bone pain
  • pancytopenia
217
Q

What presentation of nodes should be considered malignant

A

-nontender
-firm
-rubbery
immoble

218
Q

Headache red flags

A
  • <3 years old
  • HA awakens child
  • thunderclap HA
  • N/V
  • altered mental state
  • absent family history of migraine
219
Q

Headache in children management

A
  • avoid caffeine
  • avoid daily analgesics
  • possibly refer
220
Q

What age are pyloric stenosis symptoms most likely to present

A

-3-6 weeks

221
Q

Imaging study for pyloric stenosis

222
Q

Normal amount of reflux in healthy infant

223
Q

Red flags of possible pathologic reason for reflux

A
  • choking
  • coughing with eating
  • forceful vomiting
  • bilious vomiting
  • blood in stool
  • poor weight gain
  • refusing to eat
  • constipation, diarrhea
  • abdominal tenderness
  • fever
224
Q

GERD management

A
  • usually no intervention
  • avoid cigarette smoke
  • consider non-cows milk protein formula
225
Q

Acid suppressants and infants

A
  • assess feeding, sleep habits
  • assess soy and cow milk exposure
  • thickened feeds
  • avoid smoke
  • Trial: PPI for 2 weeks, if improving, extend to 2-3 months
  • refer to pedi GI if no improvement
226
Q

Reflux usually resolves by what age due to what

A
  • 1 year

- due to immature LES, matures by 9-12 months

227
Q

Most common cause of intestinal obstruction in children

A

intussusception

228
Q

Classic triad of intussusception

A
  • intermittent colicky abdominal pain (pulls up legs to chest)
  • vomiting
  • bloody mucosy stools (currant jelly)
229
Q

Preferred means of rehydration for child with viral gastroenteritis

A

commercially prepared electrolyte solution (Pedialyte)

230
Q

Retractile testes

A
  • movement of testes between scrotum and inguinal ring by cremasteric reflex
  • not associated with same risks as cryptochordism
  • send to urology
231
Q

How much time is given for a testicle to descend

232
Q

When should a hydrocele in a child resolve

233
Q

What is the most important to rule out when a child presents with hydrocele

A

-inguinal hernia

234
Q

Treatment for first ever pediatric UTI

A

-aggressive treatment to prevent PN and renal scarring

235
Q

First pediatric UTI medication treatment

A
  • consider 2nd, 3rd gen ceph if no GU abnormalities

- Ceftin, Suprax

236
Q

When is imaging for a UTI needed

A
  • 2-24 month patient with first febrile UTI treatment–> renal and bladder US
  • voiding cystourethrogram test of choice for VUR
  • Child of any age with recurrent febrile UTI
  • UTi with fam hx of renal or urologic disease
237
Q

When should BP screening begin for children

238
Q

Innocent murmur clues

A
  • grade <2
  • softer intensity when sitting compared to supine
  • not holosystolic
  • minimal radiation
  • musical or vibratory quality
239
Q

Pathologic murmur cluse

A
  • Grade >3
  • holosystolic
  • max at LUSB
  • harsh or blowing
  • systolic clicks
  • diastolic murmur
  • increased in upright position
  • gallop or friction rub
240
Q

Metatarsus adducts

A

Forefoot turned inward, may be an incomplete club foot
treat with stretching and extending
-if not stretchable, refer to ortho

241
Q

Club foot aka

A
  • talipes equinovarus

- urgent ortho referral

242
Q

Nursemaid elbow cause

A

-annular ligament slips over head of radius and becomes trapped

243
Q

Nursemaid elbow maneuver

A

-Supination-flexion technique

244
Q

Osgood Schlatter disease occurs in conjunction with

A

rapid growth spurt

245
Q

Characteristics of Osgood Schlatter disease

A
  • pain reproduced with extension of knee against resistance

- straight leg raise test negative

246
Q

Legg-Calve-Perthe’s disease

A

-osteonecrosis of capital femoral epiphysis due to interrupted vascular supply

247
Q

Trendelnburg’s test

A
  • (+) stand on affected side causes pelvic tilt (unaffected side lower)
  • positive with Legge-Calve-Perthes, SCFE, developmental dysplasia
248
Q

Slipped capital femoral epiphysis presentation

A
  • chronic hip/knee pain with intermittent limp
  • adolescent
  • refer
249
Q

Most common cause of hip pain in children

A
  • transient synovitis of hip “irritable hip”
  • benign
  • absent systemic symptoms
  • history of URI within 7-14 days
  • resolves in 7-14 days
250
Q

Exanthem

A

rash on skin

251
Q

Enanthem

A

rash on mucous membranes (Koplik)

252
Q

Roseola agent

A

Human herpesvirus 6

253
Q

Fifth disease agent

A

Parvovirus B19

254
Q

Herpangina agent

A

-Coxsackie A virus

255
Q

Fifth disease aka

A

erythema infectiosum

256
Q

Fifth disease presentation

A
  • 3 stages
  • prodrome: symptoms of URI with low-grade fever, HA, chills, malaise
  • second: slapped cheek rash, resolves in 2-3 days
  • third: rash moves to arms and legs, lacy-appearing rash, flat and appears purple, may last for a few weeks
257
Q

Roseola aka

A

Exanthem subiitum

Roseola infantum

258
Q

Roseola presentation

A
  • high fever for 2-4 days, abrupt cessation

- appearance of maculopapular rash not on face

259
Q

Herpangina presentation

A

-painful vesicles on soft palate and mouth

260
Q

Measles 3 “C’s”

A
  • conjunctivitis
  • coryza
  • cough
261
Q

AOM treatment for <6 month old

A

antibiotics

262
Q

AOM treatment for 6 month to 2 year old

A
  • certain OM: abx if severe or bilateral, observe if unilateral
  • uncertain: abx if severe, observe if mild
263
Q

AOM treatment for >2 year old

A
  • certain: abx if severe, observe if not

- uncertain: observation

264
Q

First choice medication for AOM

A
  • amoxicillin 80-90 mg/kg/day

- recent abx: Augmentin

265
Q

Referral for OM

A
  • 3 or more distinct and well-documented episodes in 6 months
  • 4 episodes in 12 months
266
Q

First permanent teeth to appear

A

-first molars

around 6 years old

267
Q

What to do with child with nits and no itchyness

A
  • if more than 1/4 inch from scalp and no itching –> most likely not viable
  • remove nits by soaking head with distilled vinegar which will break down the protein of the nit casings, making it easy to comb them out of the hair
268
Q

non-amphetimine ADHD medication

A
  • Straterra (Atomoxetine)

- SNRI

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