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IPAP > Pediatrics: Block 1 > Flashcards

Pediatrics: Block 1 Flashcards

1
Q

What two phases is the prenatal period divided into?

What period overlaps the Prenatal and Postnatal periods?

A

Embryonic- first 8wks
Fetal- after 8wks of gestation

Perinatal- 20-28wks of gestation through 1-4 weeks after birth

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2
Q

Define Perinatal Mortality

What are the two most common causes of it?

A

Fetal death between 20wks EGA through 28 day pos-delivery

Congenital abnormalities
Prematurity <37wks

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3
Q

What is the range for normal respiration for newborns?

What is the range for normal heart rates? What ranges are indicative of necessary interventions needed?

A

30-60/min

120-160
>100: routine care
60-99: ventilation
<60: ventilation and chest compressions

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4
Q

What is the correlation between pediatric age, HR, BP and R?

How many chest compression and compression/breath ratio during NRP?

A

As they get older HR and RR decreases, BP increases. “Adult-like” around 12 y/o

120bpm
3 compression : 1 respiration w/ two thumbs method (preferred) or two finger method

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5
Q

When placed supine on tables, what breathing position do babies take?

When administering O2 to newborns by blow by, how much is used?

A

Sniffing position

Blow by= 10L/min @ < 1/2” from face
BVM= sniffing position @ 40-60/min
Intubated= done if no chest rise/fall w/ BVM and allows for med delivery and preferred for transport

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6
Q

What is done for neonatal HOTN?

What drugs are given for HR?

What drugs are given for opioid use/abuse?

A

10mL/kg NS or LR

Epi 0.1-0.3mL/kg or 1 : 10,000 for IV/ETT for Asystole/Brady and unresponsive to O2

Narcan- narcotic/opioid reversal 0.1mg/kg IV/IM/ET

DONT if mom is addict/methadone, leads to withdrawal seizures
USE if mom received opioids/short term use during delivery

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7
Q

What type of issues are seen in Hemorrhagic Disease of Newborns?

A

Generalized echymosis
GI bleeds
Umbilical stump bleeding
Circumcision bleeding

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8
Q

If baby is bottle fed, what does the formula need to contain when 4-6mon of age is reached?

A

Fe- deficiency risk starts at 4mon,
Starting @6mon: 1mg/kg/day, max 15mg
Vit D- 400 IU/day for first days of life; deficiency= rickets, most common in first 2yrs of life

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9
Q

What are the results of rickets in babies?

A

Craniotabes- thin skull, fells like ping pong ball
Thickened wrists/ankles
Rachitic Rosary- costochondral junction enlargement
Enlarged anterior fontanelle/delayed closure
Bow leg/knock knees

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10
Q

During a newborn exam, what does an enlarged anterior fontanelle greater than 5cm suggests ? issue

Define Craniosynostosis

A

Hypothyroidism

Closed fontanelles

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11
Q

Define Leukocoria

During newborn exams, how would congenital heart d/os present?

A

White reflex in the eye
Can be cataract, retinoblastoma, chorioretinits, hyperplastic primary vitreous, retinopathy of prematurity

Systemic Sxs, murmur may not be heard

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12
Q

What are the negative, false result and positive screenings for pulse oximetry for newborn screening and what are the next steps?

A

All 3 done at 24hrs of life or shortly before discharge
95% or more on R hand/foot w/ 3% difference= negative screening, plan for discharge

90-94% and 3% or less difference= repeat screening in 1hr. If repeat results are in low range, repeat again in 1hr. 3 readings in this range need echo

<90% in R hand or foot= positive screening result, Echo

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13
Q 
What do each of the following findings during a newborn exam indicate?
Weak pulse
Bounding pulse
Single second heart sound
Continuous harsh holosystolic murmur
Grade 3 or higher murmur
Hepatomegaly
A 
Poor CO- aortic stenosis
High CO- PDA
Cyanotic HDz- truncus arteriosus, hypoplastic left heart
Pathologic
Pathologic
Pathologic
L HF
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14
Q

Newborn exam should show a soft and round abdomen, what does a scaphoid shape mean?

Define Barlow and Ortolani maneuvers

A

Diaphragm hernia

Hip dysplasia indicator test
Ortalani- clunk of hip relocating anteriorly

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15
Q

What are the risk factors of congenital hip dysplasia

How is it evaluated?

A

Female, FamHx, Breech, First born, Oligohydramnios, Post natal swaddling

US suspicious findings or risk factors @ 4-6wks old

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16
Q 
When are the following reflexes gone by
Fencer/Asymmetric neck reflex
Trunk Incurvature/Galant
Placing
Rooting- turns cheek to stimulus
Moro
Grasp
Babinski
A 
3mon
4mon
4-6mon
4-6mon
6mon
6mon
12-28mon
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17
Q

Define Caput Succedaneum

Define Cephalohematoma

A

Common boggy edematous swelling of scalp that crosses suture lines and resolved in 3 days

Less common swelling that doesn’t cross suture lines and resolves in wks/mon but can lead to jaundice

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18
Q

Define Subgaleal Hemorrhage

A

Rare subaponeurotic bleeding result of vacuum delivery that crosses suture lines and pushes ears anteriorly and increases risk of jandice; Tx by compression and resuscitation

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19
Q

Define Epstein Pearls

Define Vernix Caseosa

A

Keratin cysts, resolve in first weeks
Salivary tissue- Bohn nodules

Chalky white/gray mixture of epithelial cells, sebum, keratin and hair
Common in pre-terms
Thought to be protective/lubricant in womb

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20
Q

Define Milia

Define Milia Rubra

A

White smooth papules on face/scalp from epidermal occlusion of pores
Self limited and resolving

Overheated/febrile heat rash as erythematous papules
Tx by correcting over heating

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21
Q

Define Mongolian Spot

Define Cafe Au Lait Macules

A

Blue/black pigments on lower back/butt in AfAm/Asian/Indian infants that fades in life
Must be documented

Sharply defined oval macules/patches
6cm or larger Cafe or 5cm or larger diameter need further eval of neurofibromatosis, tuberous sclerosis, McCune-Albright Syndrome

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22
Q

Define Nevus Simplex

Define Nevus Flameus

A

AKA Salmon Patch
Stork bite- nape of neck
Angel kiss- forehead/eyelid
Transient and benign

Port wine stain from malformed capillary bed
Must consider Sturge-Weber Syndrome on face (trigeminal nerve distribution)

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23
Q

Define Erythema Toxicum Neonatorum

Define Neonatal Acne

A

Pustules w/ erythematous base appearing on back and trunk 24-48hrs after birth that lab results will show eosinophils and resolves in 2wks

Acne on cheeks/scalps in first few weeks of life from maternal estrogen

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24
Q

Define Cutis Marmorata

Define Cradle Cap

A

Mottling
Physiologic response to cold, resolves w/ warmth that decreases w/ age
If persistent: hypothyroid, vascular/congenital issue

Seborrheic Dermatitis
First sign of atopic dermatitis
Can treat resistant/persistant cases w/ mineral oil, white petrolatum emollient or medicated shampoo

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25
Q

Define Umbilical Granuloma

A 
Red papule from umbilical stumps and resolved w/ silver nitrate
Distinguish from:
Urachus- urinary d/c
Meckels
Vitelline Duct
Talc granulomas
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26
Q

Define Metatarsus Adductus

A

Most common foot disorder in infants
Medial deviation of mid and forefoot, can lead to hip dysplasia
Dx- mid-heel bisector line should go between toe 2 and 3; V-finger should not gap at 5th MT
Tx- most spontaneous, serial casting, bracing, surgery

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27
Q

Define Talipes Equinovarus

A 
Clubfoot, Limp Hypoplasia
Calf atrophy and foot shortening, half are bilateral
Congenital- 75% of cases
Teratological- myelomeningocele
Positional from in utero
Tx w/ serial cast or surgery
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28
Q

Define Spina Bifida

A

Lumbosacral neural tube defect, Cleft Spine
Dx during 2nd trimester from maternal AFP and US
Rachischisis- hair tuft
Meningocele- meninges through neural arch
Meningomyelocele- meninges and cord through arch
Myeloschisis- open skin, cord exposed

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29
Q

How can spina bifida be prevented during pregnancy?

Facial pasly after birth is indicative of ?

A

Folate

Forcep delivery

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30
Q

Define Erb-Duchenne Palso

A 
C5-6 and Phrenic nerve lesion
\+ Grasp reflex
- Bicep reflex
Waiter tip palsy
From difficulty delivery- shoulder dystocia
Resolves w/ PT and observation
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31
Q

Define Klumpke’s Palsy

A 
C8-T1 lesion
- Grasp reflex
\+ bicep reflex
Claw hand
Ipsilateral Horner's Syndrome
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32
Q

What are the two types of hydrocephalus

A

Communicating- w/ subarachnoid
Non-communicating- obstructed
Tx w/ Ventriculoperitoneal shunt

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33
Q

What are the risk factors of neonatal sepsis

A 
Prematurity- 6x greater
Prolonged membrane rupture
GBS
Maternal fever
Amnionitis
Fetal tachycardia
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34
Q

What are the common etiologies of early onset neonatal sepsis

What are the causes of late onset?

A

GBS, E Coli, Klebsiella, Listeria M., Salmonella, Mycoplasma

H Influenzae, Staph, HSV, CMV, Enterovirus, S Pneumo, N. Meningitis

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35
Q

What is early onset neonatal sepsis

What is late onset?

A

0-7 days old; fast onset and quick progression to severe Sxs: fever, hypothermia, HOTN, Resp Distress

8-28 days old; isidious onset w/ fever, poor feeding, lethargy, bulging fontanelle, poor muscle tone, seizures, direct hyperbilirubinemia; more likely associated w/ meningitis

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36
Q

What labs are ordered to evaluate neonatal sepsis?

A

CBC, Cultures x 2, UA, Urine culture, Blood glucose
CXR
LP for culture, stain, protein and glucose

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37
Q

How is neonatal sepsis treated?

A 
IV Ampicillin and Gentamicin or;
Ampicillin and Cefotaxamine
Draw labs and continue until:
- culture results
Sepsis confirmed- 14 day Tx
Meningitis confirmed= 21 days Tx
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38
Q

What two ABX can be added to neonatal sepsis treatment

A

Vancomycin- if late onset of miningitis is present
Acyclovir- concern for HSV infection
Support- IV fluid, nutrition

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39
Q

What are the 3 steps for GBS treatment of the mother?

A

1- infant Sxs; yes= full eval and empiric Tx
2- child <35wks EGA; yes= limited eval and 48hr observation
3- mother receive 2 ABX doses prior to delivery; yes= no eval or therapy, observe 48hrs

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40
Q

RDS is AKA and is what issue?

A 
Hyaline Membraine Dz
Insufficient surfactant production by Type 2 Pneumatocytes
Commonly seen <34 wks EGA
Ends w/ End-Expiration Atelectasis
CXR shows bilateral ground glass
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41
Q

How can RDS be prevented prior to birth?

How is it treated after birth?

A

Steroids at 32-34wks

Intubation and respiratory support by artificial surfactants via ET tube

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42
Q

Define PDA and what type of issue is it

How is it treated?

A

L to R shunting from high to low press that becomes apparent 2-4 days of life but can result in HF, pulmonary edema or hepatomegaly

Fluid restriction and diuretics
Indomethacin or Ibuprofen

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43
Q

What causes Bronchopulmonary Dysplasis and how is it treated?

A 
O2 toxicity/barotrauma
Presents as required O2, Poor Growth, Hypercapnea, PHTN, R HF
Inc risk in those who:
O2 dependence at 36wks
RDS fails to improve after 2wks
Prolonged mechanical ventilation
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44
Q

What causes Retinopathy of Prematurity

A

Acute and Chronic effects of O2 toxicity

Leads to neovascularization, retinal detachments or fibrous proliferation behind lens

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45
Q

What are the 2 types and causes of Premature Apnea

How is it treated

A

Central- medulla and pons don’t stimulate phrenic nerve (majority but usually has peripheral component too)
Peripheal- airway obstruction

O2, Caffeine/Theophylline, Anemia Tx

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46
Q

Define Tracheomalacia

A

Weak/floppy tracheal cartilages
Worsens: cry, cough, feed or URIs
Possible high pitch/rattling noise

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47
Q

What 4 issues can develop into Meconium Aspiration Syndrome

What delivery airway interventions are done?

A

Respiratory distress, Pneumonia, Pneumonitis, Pneumothorax

Nonvigorous child= intubate and suction
Vigorous- no routine intubation or suction

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48
Q

How does MAS look on CXR?

A

Coarse irregular infiltrates

Predisposed to chemical/bacterial pneumonia and pneumothorax

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49
Q

What causes Transient Tachypnea of Newborns?

A

Retained amniotic fluid causing mild hypoxia and resolves in 24hrs
CXR shows fluid in fissures
More common in C-Section or LGA infants since they don’t get squeezed during delivery

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50
Q

What are the two types of PHTN

A

Primary- hypoxia w/out cardiac/pulmonary dz; normal CXR; inherited/autoimmune, drugs
Non-Primary- result of other process PFO, PDA

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51
Q

What is the most common cause of neonatal anemia

What test is done to assess anemia from maternal-fetal hemorrhage?

A

ABO incompatibility

Kleihauer-Betke test

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52
Q

What is the most common cause of neonatal jaundice?

Define Breastfeeding Jaundice
Define Breast Milk Jaundice

A

Hemolytic Dz of newborns

Insufficient milk production/ingestion

Unknown milk factor that inhibits bilirubin conjugation or enzyme that enhances bilirubin absorption

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53
Q

Characteristics of Physiologic Pattern Jaundice

Characteristics of Pathologic Patter

A

Evidence of jaundice starting when Bili levels get to 5-10; starts on face and moved to trunk, concerning if past umbilicus
Term= 12 or less on day 3
Pre= 15 or less on day 5

Early /fast, >13mg/dl on day 1 (always pathologic), jaundice set in within 24hrs
Hepatosplenomegaly and Anemia
Inc of >0.5mg/dl/hr, onset within first 24hrs and peak over 12= abnormal

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54
Q

What can cause Physiologic Jaundice

A 
Insufficient UDPGT activity= no conjugation
Insufficient intestine bacteria
Dec intestine motility
Altitude- +3100m
Race- Asian, Greek
Premature
Breast feeding
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55
Q

What causes Breast Milk Jaundice

A

Adequate intake
Fatty acids displace bilirubin from albumin (unconjugates)
Factor enhances intestinal bilirubin
Occurs 7-10 days after birth
Unconjugated hyperbilirubinemia w/out hemolysis
Bilirubin rarely rises above 20mg/dL

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56
Q

What labs are ordered for Neonatal Jaundice

A 
Total bili
CBC, Blood type
Coombs- tests for Abs on RBCs
Peripheral smear
Retic count
Test G6PD deficiency
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57
Q

Define Kernicterus

A

Bilirubin Encephalopathy
Lipid solube, unconjugated indirect bilirubin that accumulate and are CNS toxic
Usually does NOT develop in term infants but are predisposed if other issues are present

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58
Q

How does Kernicterus manifest clinically

A

Early: Lethargy, Hypotonia, Irritable, Poor Moro response, Poor feeding, High pitch cry usually seen on day 4 of life

Late: bulging fontanelle, opisthotonic posturing, pulmonary hemorrhage, fever, hypertonicicty, paralysis of upward gaze, seizure

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59
Q

How are different severity of neonatal jaudince treated?

A

Mild- lifestyle changes, increase feeding, sunlight
Moderate- phototherapy
Severe- transfusion (indirect Bili @ 20 in infants w/ hemolysis and weight +2000g; indirect Bili >25 in ASx infants w/ physiologic or breast milk jaundice

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60
Q

What are the adverse effects of neonatal phototherapy?

A

Short: Diarrhea, interfered bonding, intestinal hypomotility, temp instability

Long: Childhood asthma, Type 1 DM

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61
Q

What are the timing intervals for jaundice evaluation of healthy term neonates post-hospital discharge

A

Discharged before:
24= 72hrs
24-47.9= 96hrs
48-72= 120hrs

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62
Q

What are the age ranges for Neonate, Infant, Toddler, Pre-Schooler, Child, and Adolescent?

A 
N 0-28 days
I 29-1y
T 1-3y
P 2-5y
C 1-12y
A 13-18y
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63
Q

What are the criteria for underweight, normal, overweight and obese

A

Under= <5th percentile
Normal= 5-85th
Over= 85-95th
Obese- >95th

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64
Q

During childhood, what part of growth typically doesn’t cross percentile lines?

When does sigmoid shaped growth occur?

A

Height

Adolescence, accounts for 15% of adult height

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65
Q

How does weight change from day of birth to first year of life

A

5-10% of birth weight lost in first few days
Return to weight by day 14
Double 4-5mon
Triple- 1yr
Daily gain- 20-30g first 3-4mon; 15-20g for rest of first year

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66
Q

Average baby length is _in at birth and _in by 1st year and _in by 4yrs

What is the average head circumference

A

20, 30; double birth length or 40in

35cm at birth
Inc 1cm/mon for first year; 2cm/mon for first 3mon then dec

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67
Q

How long are head circumference serial measurements taken?

When do abnormal growth patterns require action to be taken?

A

Until 2yrs old

Infant <5% w/ no obvious cause
Infant crosses two percentiles or major channels w/out cause
Large discrepancy between head circumference, height, weight

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68
Q

In general, half of a child’s growth occurs during ?

Babies that are small for gestational age or are premature do catch up growth when?

A

First 2yrs of life and usually remains in the same channel

First 6mon

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69
Q

What is the mid parental method of height prediction equations?

What is the 2 year x 2 method equation:

What is the most accurate method

A

Male: Dad + Mon/2 + 2.5
Female: same but -2.5

Inches at 2 x 2

Bone age- xray of hand

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70
Q

What are the 5 developmental areas assessed during ASQs?

When is DDST-II used?

A

Communication, Gross motor, Fine motor, Problem solving, Personal-Social

0-6yrs, assesses 4 areas: Personal-Social, Fine motor-adaptive, Language, Gross motor

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71
Q

What is the M-CHAT

A

Modified Checklist for Autism in Toddlers
Autism Screening done at 18-24mon that checks 23 behaviors

> 2 predictive or >3 total behaviors require additional assessment

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72
Q

What milestones are seen at 2wks old?

A

Gross motor: moves head side to side
Personal social: regards face
Language: alerts to bell

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73
Q

What milestones are seen at 2mon old?

A

Gross motor: lifts shoulder when prone
Fine motor: tracks past midline
Personal social: smiles responsively
Language: cooing, searches w/ eyes

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74
Q

What milestones are seen at 4mon old?

A

Gross motor: lifts up on hands, rolls f-to-b, no head lag
Fine motor: reaches, raking grasping
Personal social: looks at hands, works towards toys
Language: laughs and squeals

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75
Q

What milestones are seen at 6mon?

A

Gross motor: sits alone
Fine motor: transfers objects in hands
Personal social: feeds self,
Language: babbles

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76
Q

What milestones are seen at 9mon?

A

Gross motor: pulls to stand, seating postion
Fine motor: pincer grab, bangs blocks together
Personal social: waves by, plays patty cake
Language: says non-specific two syllable words

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77
Q

What milestones are seen at 12mon?

A

Gross motor: walks, stoops and stands
Fine motor: puts blocks into cups
Personal social: drinks from cups, initiates others
Language: says mom/dad and one/two other words

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78
Q

What milestones are seen at 15mon?

A

Gross motor: walks backwards
Fine motor: scribbles, stacks blocks
Personal social: uses spoon/fork, helps in housework
Language: says 3-6 words, follows commands

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79
Q

What milestones are seen at 18mon?

A

Gross motor: runs
Fine motor: kicks ball, stacks 4 blocks
Personal social: removes clothes, feeds dolls
Language: says 6 words

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80
Q

What milestones are seen at 24mon?

A 
Gross motor: goes up and down stairs
Fine motor: stacks 6 blocks
Personal social: washes/dries hands
Language: puts two words together
Other cognitive: understands concept of 'today'
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81
Q

What are the red flags of gross motors are concerning if seen at certain time frames?

A

Rolling prior to 3mon= increased tone
Poor head control by 5mon= hypotonia
Lack of sitting by 7mon= hypotonia
Hand dominance before 18mon= contralateral neuromotor abnormality

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82
Q

What are the red flags of language development?

A 
1st think hearing
Failure to vary voice pitch by 4mon
Lack of babble/localizing sound by 6mon
No true words/gestures by 15mon
No protodeclarative pointing by 18mon
Less that 50% intelligible speech by 2yrs
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83
Q

All kids with speech delay get what series of exams?

Visual exams are performed at every visit until what age?

A

Tympanometry, Audiometry- Auditory Brain Stem Response to r/o peripheral hearing loss

2y/o

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84
Q

When do general exams occur in peds lives?

Normal development should show what type of BP by 3yrs old?

A

3-5 days, 2wks
Mon= 2 4 6 9 12 1 5 18 24 then annual

SBP= 80 + (age x 2)
DBP= 2/3 of SBP
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85
Q

What is one growth marker/assessment that is conducted at every appointment?

What screening tests are performed on kids?

A

Obesity

Metabolic, Hgb Electrophoresis, Hearing eval

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86
Q

When are anemia screenings conducted?

How much lead does it take to cause learning issues?

A

12mon if healthy, 4mons if at high risk

5-10 ug/dL, screened at 12 and 24mon
Screening questions from 6mon-6yrs, may be required prior to starting Kindergarten

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87
Q

When is TB screening conducted?

When are kids lipid panels assessed?

A

After 12mon

9-11yrs and 17-21yrs
If parents have Cholesterol >240 or premature CAD, start at 2y/o
Normal total cholesterol <170

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88
Q

How often are STI screenings done and what is tested for?

When are Paps and HPV done?

A

Annually after any form of intercourse
G/C, syphilis, Hep B and HIV

21y/o

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89
Q

Define Active Immunity

Define Passive Immunity

A

Induces immunity from vaccine/toxoid (inactivated toxin)

Induces transplacental transfer of maternal Abs and administration of Ab (immunoglobulin or monoclonal Ab)- breast feeding

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90
Q

How often are premature babies vaccinated?

A

Regardless of weight, same chronologic age/schedule as full term kids
ONE exception- Hep B for <2000g; if mother is Hep B surgace Ag negative then give at 1mon instead of birth

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91
Q

When are adolescents given vaccines?

Which vaccine has mercury and why is it of concern?

A

11-12yrs of age w/ completion of series by 13-18yrs
N Meningitides booster at 16yrs

Thimerosal- trace amounts found in flu vaccine but was banned in 2001 and autism cases have increased

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92
Q

What is the Hep B series

A

3 doses, 1st dose at birth/within 24hrs

Exception, underweight <2000gm

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93
Q

What is the DTap Series

A

5 doses given at 2 4 6 and 15-18mon and 4-6yrs old

1 adult dose at 11-12y/o

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94
Q

What does the HIB series prevent?

What was the IPV series discontinued?

A

Reduces risk of meningitis and epiglottis

Only known cases of vax-induced polio in US

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95
Q

What is MMR given?

When is MCV4 (Menactra) given?

A

Mumps- resurgence in adolescents
Rubella- prevent fetal malformation
Measles- from overseas

Meningococcal, given 11-2y/o or prior to college
Consider at 2-10 if splenc disfunction/immunocompromised

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96
Q

When is Hep A given?

How old do kids need to be before influenza vaccine is given?

A

2 shots between 1-2yrs

6mons or more

97
Q

What does Prevnar vaccine prevent?

Why is Varicella used?

A

Pneumoccocal

Secondary cellulitis and pneumonia, reduces shingles

98
Q

When is the HPV series given?

Facts of Rotavirus

A

9-26y/o
Given prior to exposure, protects 75% from cervical CA and 90% of genital warts

Live attentuated cow rotavirus; first dose MUST be at 15wks, final dose NLT 8mon

99
Q

When are vaccines contraindicated?

Which vaccines are ‘live” vaccines?

A

Anaphylaxis
No live vaccines in immunocompromised or pregnant PTs

MMR, Rota, Smallpox, Varicella/Chicken Pox, Yellow fever and Nasal influenza

100
Q

What are the basic guidelines for doing Peds exams when they’re from birth to 6mon?

What about 6-36mon?

36mon and older?

A

No stranger fear, easily comforted by parents, easily distracted

Fearful of adults/strangers
Harder to restrain
Moody

Less fear, more interaction

101
Q

What recommendations are offered to providers when examining Peds that may be difficult?

How long are kids recommended to sit in car seats?

A

Sit at distance, observe interaction w/ parents, start w/ heart/lungs and save ears/mouth for last

Until 2yrs or reach weight/height limit of seat

102
Q

How long are kids recommended to sit in booster seats?

Define SIDS

A

Until 4’ 9” and 8-12yrs
<13 should be in back seat and w/ seat belts

Unexpected death of infant under 1y/o after autopsy, investigation and review of clinical Hx- Dx of Exclusion

103
Q

What are the stats associated w/ SIDS?

What position do babies sleep in and what can be offered that are beneficial

A

3rd leading cause of infant death in US, most common cause of death in ages 1mon-1yr

On back, Pacifier

104
Q

Kids exposed to tobacco smoke are at risk for ?

How does tobacco cessation rank among quitting?

A

LBW, SIDS, Respiratory illness, Otitis media, Asthma

Harder than alcohol, heroin or cocaine

105
Q

Define Plagiocephaly

A

Asymmetric head shape
Risks: first born, premature, limited tummy time, no position changes during sleep
If normal= no x-ray, improves in 2-3mon
Tx: supervised tummy time, treat torticollis
If unresolved after 4-6mon, refer

106
Q

What predicts adult stature and some health outcomes for Peds?

What are the major risk periods for growth stunting?

A

Nutrition and growth in first 3 yrs

4-24mon

107
Q

Mothers taking anti-thyroid drugs are recommended to take ? ones if breast feeding?

What pediatric issues are contraindications of breast feeding?

Pumped breast milk needs to be refrigerated and used with ? hrs

A

Propylithiouracil preferred over methimazole

Galactosemia, PKU

48hrs or frozen and stored for up to 6mon
Once thawed, use in 24hrs
NEVER microwave

108
Q

What type of formula is used when absorption/digestion is a medical problem?

If kids are allergic to cows milk they may also be allergic to ?

A

Casein Hydrolysate

Protein in soy formula

109
Q

Why are no formulation substitutions before 12mon old recommended?

What are the criteria of peanut/food allergy?

A

Scurvy, anemia or nutritional deficits

1= severe eczema, egg allergy or both, earliest attempt at 4-6mon 
2= mild/mod, attempt at 6mon
3= no eczema or allergy, attempt as age appropriate
110
Q

Limit cow milk intake in toddlers to what amount?

What is defined as child obesity?

A

<24oz/day, can reduce intake of food diversity

95th percentile or higher

111
Q

Fluffy kids don’t need to be on diets before what age

When are mother’s screened for post-partum

A

3yrs

Edinburgh Post natal scale for 1st 6mon; increase activity, decrease sedentary life

112
Q

How much TV/day?

When should toilet training occur?

Home water heaters should max out at what temp?

A

Nothing before 2yrs, no more than 2hrs/day

Between 2-3y/o

120*

113
Q

If kids have delayed teeth eruption, what needs to be checked?

When do permanent teeth show?

A 
TSH and Ca (hypo thyroid, hypo pituitary, rickets)
Osteoporosis
Gaucher Dz
Down Syndrome
Celidocranial dysplasia

Begin 6yrs, end 12yrs
3rd molar @ 18y/o

114
Q

Sequence of primary teeth eruption

A

Slide 98 Lect 2

115
Q

How is infant oral hygience accomplished

Don’t use fluoride toothpaste before what age?

When are dental visits started?

A

Rubbing gums w/ wet washcloth/infant toothbrush

2y/o, community water w/ 2ppm is effective

1y/o, cleanings q6mon

116
Q

What are the most psychological damaging comments parents can make to kids?

What kinds of disciplines threats are appropriate

A

Leave/give up kids

Mild loss of privileges

117
Q

Define Extinction discipline

How much time out is used?

A

Eliminates frequent/annoying and harmless behavior through ignoring the kids actions

One minute per year of life

118
Q

What is the definition of FTT

A

Weight <3rd percentile
Weight decreases, crosses two major percentile lines
Weight <80% of median weight for height

119
Q

What are the 3 types of FTT

A

Wasting- deficient weight gain from malnutrition
Shunting- deficiency in linear growth but head circumference is spared
Symmetric- proportional weight, height and head from long malnutrition, chromosome abnormalities, infections/exposures

120
Q

What is the cause of FTT

What do patterns of FTT mean?

A

Insufficient usable nutrition at the cell level

Dec weight after certain age= infection, endocrine, environment
Body asymmetry= epiphyseal, chromosome issue

121
Q

If a Peds PT is hospitalized for FTT, what results can be seen and what do they mean?

A

Feeds fine/gains weight= poor home feeding
Feeds normal, doesn’t gain weight= malabsorption, endocrine, metabolic dz
Infants that feed poorly in hospital= neuromuscluar, poor intake or frequent regurg

122
Q

What Hx ?s are asked during a FTT issue?

What are the parts of a FTT physical?

A

Hx on prenatal, birth, medical, family, nutritional/stool and social

VS, Ht, Wt, HC
Impression
Full head to toe exam

123
Q

What labs are ordered in FTT visit?

How is premature FTT weight calculated?

A

CBC, Fe, UA w/ culture, Serum E+, PPD, LFTs, HIV, Stool culture, lead and TSH

Adjusted until 24mon
HT correction until 40mon
HC correction until 18mon
Birth age - # of wks premature

124
Q

Bone age > chronological age is seen in ? issues

Bone < chronological age can mean ?

If bone age = chronological age and no other abnormal findings are seen then ?

A

CAH, Premature adrenarche, excess sex steroids, overweight

insufficient GH, hypo thyroid or constitutional growth delay

Probably hereditary short stature

125
Q

How is FTT treated?

When are FTT PTs admitted for in patient care?

A

Increase calorie/protein intake by >1.5x

Severe, underlying Dx requiring hospitalization, safety is jeopardized or failed out patient

126
Q

Why does Refeeding Sydrome cause death?

A

New food sitmulates glycogen/fat/protein synthesis which requires E+ that are already depleted leading to deficiencies:

Loss of fluid/E+ homeostasis causing loss of phosphorous, Mg, and K and causing fluid retention leading to cardiac, pulmonary and neurological p

127
Q

What type of genetic issues are most common at birth?

What are examples of autosomal dominant inheritance issues

A

Multifactorial defect

Achodroplasia, Neurofibromatosis, Huntington,s Marfans, Polycystic Kidney

128
Q

What are examples of autosomal recessive Dzs?

What are X-linked issues?

A

CF, PKU, CAH, SS,

Fragile X, Muscular Dystrophy, Hemophilia A, G6PD, Color blindness

129
Q

Autosomal dominant= ?

Autosomal recessive= ?

A

Hetero or homozygous expression from one gene, both sexes equally effected

Homozygous expression from two genes, usually born to unaffected parents

130
Q

X chromo carries ? genes while Y carries ? genes

A

X= 500
Y= 50
Males more common, all daughters of affected males will be affected, no father-son transmission and may skip genes

131
Q

Define Genotype

Define Phenotype

A

Type of genes

Physical characteristics

132
Q 
These AKAs are for ? Dz
Trisomy 21
Excessive base repeats
45XO
47XXY
Autosomal dominant CT d/o
A 
Downs- mongoloid previous term no longer used
Fragile X
Turner
Klinefelter
Marfan
133
Q

Facts of Downs Syndrome

A

Method of inheritance= Increased risk w/ maternal age and parents genetics (maternal nondisjunction)

All kids need genetic studies, if translocation is present= parents need screening

134
Q

What are the 3 types of TS21?

A

3 copies- mos common, from maternal nondisjunction
Translocation- carrier state w/ higher baseline maternal nondisjunction rate
Mosaicism- phenotypically normal

135
Q

What is the take away from Down’s maternal age and incidence?

A

Incidence higher in older women

Downs kids are born more commonly to younger women due to more births

136
Q

What are the phenotypical features of Downs

A 
Hypotonia, decreased Moro reflex
Small head
Up slanting fissures- opening between eye lids
Epicanthal folds
Midface hypoplasia
Dyspastic pinna- small ears
Macroglossia
137
Q

What are the phenotypical features of Down’s extremities

A

Single palmar crease- don’t use term ‘simian”
Shortened 5th finger
Widened firs toe space
Shortened/stubby fingers

138
Q

What medical conditions are Down’s PTs more susceptible to?

A 
Development delay
Hearing/eye loss
GI/Cardiac abnormalities- ASD, VSD, Eisenmengers
Hypothyroidism- life long issue
Polycythemia
Leukemia
139
Q

What types of hearing losses do Down’s suffer from?

A

Sensorinueral- issues w/ CN8
Conductive from dysplasia of ossicles and scarring from ear infections

Hearing screening q6mon until 3y/o then annual

140
Q

What eye defects are seen in Down’s

A 
Ophthalmology exam by 6mon
Brushfield spots- white/gray spots on periphery of iris
Cataracts
Ectopic lens
Refractice errors
Strabismus- cross eyed
141
Q

What is the first Sx to be seen suggesting Down’s PT is suffering from R sided HF?

What is the ‘double bubble’ sign seen in these PTs?

A

Clubbing, cyanosis in lips
Echo done routinely

Esophageal/duodenal atresia

142
Q

What type of cervical issues do Down’s have?

What labs are drawn/tested annually?

A

Atlantoaxial instability
C-spine x-ray by 3-5y/o

TSH, CBC, Celiac

143
Q

Fetal alcohol syndrome is the severe manifestation of ?

A

Fetal Alcohol Spectrum D/o

144
Q

What is the most common cause of preventable development and intellectual delays?

Kids living in what 3 areas are more susceptible?

A

FASDs

Poverty, American Indian, Foster care

145
Q

What are the common physical characteristics of FAS?

What are the less common features

A

Short palpebral fissures
Smooth philtrum
Thin upper lip

Rail road track ears
Ptosis
Microcephaly
Epicanthal folds

146
Q

What extremity, cardiac and developmental abnormalities are seen in FAS PTs?

A

Clinodactyly
Hockey stick crease

VSD, ASD

Retardation, fine motor delay, ADHD

147
Q

Mothers are referred to therapy to prevent FAS if how much is consumed?

FAS Tx is a multi-specialty team effort including?

A

> 7 drinks/wk
Multiple periods of >3 drinks/wk

ADHD, Anxiety, Speech, SpecEd

148
Q

What chromosomal issue causes Fragile X Syndrome

What neurological problems appear?

A

Excess CGG base triplet repeats at 5’ end of FMR1 gene on the X chromosome

Hyper arousal/anxiety
Epilepsy
Autism spectrum d/o

149
Q

What physical attributes are related w/ Fragile X

How is it officially Dx?

A

Large head, oblong face
Macro-orchidism
Joint laxity
Hypotonia

DNA amplification w/ direct analysis

150
Q

How is Fragile X treated?

A

Genetic counseling, Spec Ed
Autism eval
Neuro referral

151
Q

What are the 3 variants of Turner Syndrome

A

50% lack X
25% have abnormal X
25% are mosaic

Phenotypic female w/ absent/dysfunctional X chromosome

152
Q

What mental development issue and increase is seen in Turner’s?

What cardiac issues are seen?

A

Normal development, poor visual/spacial skills
Superior verbal skills

Coarctation, bicuspid aorta, early HTN

153
Q

What endocrine issues are seen in Turners

How is Turners Dx

A

Amenorrhea/infertile
Hypo thyroid
DM Type 1
Osteoporosis

Direct Karyotyping
Barr body (inactive X chrom) analysis not recommended due to high % of mosaics
154
Q

How is Turner’s treated?

What labs are tested annually?

A

Cardio consult at Dx for Echo, MRI and ECG
Endo referral for GH
Start estrogen replacement at 14y/o

TSH, Chem 7, UA

155
Q

What d/o is phenotypically normal prior to puberty

What dangerous issue can be seen rarely?

A

Klinefelter Synd

15% have mosaic variants- multi-X or multi-Yx= irregular features, violence, retardation

156
Q

Klinefelter Barr Test is same as ?

Klinefeltor Sxs are related to an issue of ?

A

XX Female

Testosterone deficiency

157
Q

How is Klinefelter Dx

How is it Tx?

A

Direct karyotyping
Inc LH and FSH w/ dec testosterone

Testosterone replacement to treat hypogonadism and cause virulization

158
Q

Marfan Synd is an issue at what molecular level?

What pos thumb/wrist sign is seen?

A

AutoDom mutation in Fibrilin 1 gene on Chrom 15

Arachnodactyly
Thumb AKA Steinberg Sign
Wrist AKA Walker-Murdoch
Both needed for Arach. Dx

159
Q

Marfans manifests in what 3 body systems?

How is it Dx?

A

Cardiac, skeletal, Ophthalamic

Clinical criteria but confirmed w/ FISH (Fluorescent In-Situ Hybridization)

160
Q

When are infant crying louder and more intense?

Premature infants cry little before __wks but cry more than term infants at _wks

A

Hunger and Pain

40wks; 6wks

161
Q

How much crying should babies be crying at 2wks, 6wks, 12wks

How much fussing is seen?

A

2: little
6: 2/hrs day
12: 1hr/day

6wks: 10 episodes/24hrs

162
Q

Corrected age equation

How long is it used for?

A

Chron age - wks premature

Until 24mon

163
Q

Define Colic

What is Wessels rule of 3

A

Difficult/fussy child that has paroxysmal crying w/ facial grimace, leg flexion and flatus

Crying >3hrs/day
Crying 3 days/wk
Crying more than 3wks
Usually resolves around 3mon

164
Q

What has been shown to be an excellent soother of colic babies?

What is more likely to be seen when colic babies are present?

A

Car rides
White noise- vacuums

Post Partum depression in mother

165
Q

What is the most commonly reported pediatric behavioral problem

What are triggers?

A

Temper tantrum- terrible twos

Tired, Hungry, Ill, Transition

166
Q

How can temper tantrums be prevented?

How are breath holding spells treated

A

Parent education at 12-18mon

Ignore

167
Q

What is the goal of therapy in special needs Peds

What do parents experience after child is Dx w/ Special Needs

A

Maximize potential for adult function

Kubler Ross stages of grief

168
Q

How are special needs kids best managed?

Define Intellectual Disability

A

Medical Home

D/os with common deficits of adaptive and intellectual function and an age onset before maturity is reached
IQ <70

169
Q

Criteria of Mild ID

Criteria of Severe ID

A

IQ 50-70, higher association w/ environment and highest risk among low socioeconomic status

IQ <50, linked to biological/genetic causes

170
Q

What developmental delay is common in PTs w/ ID?

What needs to be considered if abnormal facial features, hypotonia, FTT are seen at birth?

A

Hearing and Speech delays

Syndromes or Genetic Abnormalities

171
Q

What labs are ordered for ID PTs?

What is the school screening used to ID students needing help?

A

UA, Metabolism (PKU, TSH), Hypo thyroid, EEG, Chromosomes

Parent’s Evaluation of Developmental Status

172
Q

ID Tx is dependent on ?

What environmental risk factors increase chances of autism?

A

Stanford Binet scores, IQ doesn’t equal functional ability

Advanced age
Premature birth
Maternal obesity
Short interval from prior pregnancy
Infections
173
Q

Autism often coexists w/ what other issue?

How does Autism clinically present?

A

ID

Deficit in social communication/interaction
Restricted/repetitive actions of behavior/activities
Inflexible adherence to routines
Hyper/hypo reactive to sensory input

174
Q

Most Autism PTs have what comorbid condition

What meds are used?

A

Sleeping problem

Antipsychotic
SSRIs
Antiepileptics
Gi meds- esp constipation
Sleep hygiene
175
Q

Define Cerebral Palsy

What is a huge risk for CP?

A

D/o of movement and posture limiting activity
80% antenatal factors leading to abnormal brain development

Multiple pregnancy
Infertility treatments

176
Q

If child only walks on tip toes they have?

What other neuro S/Sxs may be seen

A

Spastic Hemiplegia

Ankle Clonus, Babinski, Inc DTRs

177
Q

What is the imaging modality preferred for CP?

A

MRI, inc sensitivity

178
Q

If child is continuously army crawling, they have ?

What other Neuro S/Sxs are seen?

A

Spastic diplegia
Damage to immature white matter

Brisk reflexes, ankle clonus and bilateral Babinksi

179
Q

What is the most common neuropathic finding in spastic diplegia?

A

Periventricular leukomalacia

180
Q

Define Spastic Quadriplegia

What will be seen on neuro exam?

A

Motor impairment of all extremities
High risk of ID and seizure, pneumonia and growth failure

Inc spasticity, dec spontaneous movement, brisk reflexes, plantar extensor responses
Athetosis is common

181
Q

Define Athetoid CP

A

Choreoathetoid, Extrapyrimidal, Dyskinetic

Hoptonic, poor head control, head lag and isolated more to upper extremeties
Slurred speech

182
Q

What causes Athetoid CP

What labs/rads are ordered?

A 
Birth asphyxia
Kernicterus
Lesion in basal ganglia/thalmus
Genetic metabolic d/o
Mitochondrial d/o

MRI and metabolic panel

183
Q

What labs/rads are ordered to Dx Cerebral Palsy

What meds can be used for spasticity

A

Hx, Clinical, MRI, Vision/Hearing, EEG, UA
Genetics

Botox, Benzo, PO MRs, Baclofen

184
Q

Difference in ADHD appearance in m/f

How is it Dx?

A

M- hyper active and impulsive
F- inattentive

<16= 6 inattention or 6 hyperactive/impulse Sxs
>17= 5 inattention or 5 hyperactive/impulse Sxs
For 6mon
In 2 or more environments

185
Q

How is ADHD Tx?

A

Behavior management- core
Stimulants- first line
NE reuptake inhibitor- Atomoxatine
A-agonist- Clonidine/Guanfacine

186
Q

Signs of ODD

Signs of CD/o

A

Angry/irritable
Argumentative and vindictiveness

Aggression, destruction and deceitfulness/theft
Serious violations of rules

187
Q

How are ODD/CD/o screened for

What meds are used for both?

A

Vanderbilt

Stimulants
Atypical antipsychotics

188
Q

Define Early, Mid and Late Adolescence

A

Early- Concrete, body/attention focused, ambivalent to independence

Mid- abstract, concern w/ identity, risky behavior, independence

Late- formal operational, marriage/job, commitments, re-emergence of unresolved separation anxiety
Failure to launch

189
Q

Define identity confusion

Define Role Confusion

A

Search for commitment before identity roles are formed- experimentation

Reluctant to make commitment and develops avoidance

190
Q

What is the acronym for doing adolescent interviews

A 
HEADDSS
Home/friends
Education
Alcohol
Drugs
Diet
Sex
Suicide/depression
191
Q

Series of events that lead to sex hormone production

Interference with this process can be caused by ? and lead to early puberty

A

Hypothalamus inc GnRH
Ant Pit releases FSH/LH (pulse generator)
Hormones triggered

CNS d/o, tumor

192
Q

First part of female development is ?

What is second?

A

Estrogen, Breasts

Adrenal- androgen

193
Q

What are the Tanner stages of breast development

A 
1- preadolescent
2- buds
3- enlargement of breast/areola
4- areola and papilla mound
5- mature
194
Q

What are the Tanner stages of female pubic hair?

A 
1- none
2- sparse along labia
3- dark/coarse over pubes
4- covers but not to thighs
5- covers to thighs
Peak growth 3-4
195
Q

When do female menarche begin?

A

2.5-3yrs after breast development
Tanner 4 breast Physiologic leukorrhea 3-6mon prior
2-3yrs post-thelarche
Avg- 4/2yrs

196
Q

What is the first part of male development?

A

Testosterone, inc testes size

SMR 2

197
Q

What are the Tanner stages for male pubic hair

A 
1- childhood
2-testes enlarge
3- penile length
4- penile breadth
5- adult
198
Q

What are the Tanner stages of

A 
1- none
2- sparse, base of penis
3- darker, coarse, curled
4- covered but not thighs
5- thighs
Avg- 2.5-5yrs
199
Q

Define Leukorrhea

When do gynecomastia cases need to be referred to Endo?

A

Tanner stage 3 event- vaginal discharge of clear/non-odorous due to estrogen stimulation of uterus/vagina

> 3cm
Persists after 2yrs
Past age 16yrs
Tanner 1, 2, 5

200
Q

DDx of premature Thelarche

Male testes should not enlarge before ? age, and if the do ?

A

Estrogen excess- soy, legumes, flax seed, tofu

Prior to 9, brain MRI

201
Q

Define Adrenarche

What are DDx

A

Odor, hair, acne
F: <8 M: <9

Cushings, Tumor, Adrenal hyperplasia

202
Q

What can be given for obvious gynecomastia?

How long are female cycles?
How long does each last?
How much is normal flow?

A

Androgens, Aromatase inhibitors, Estrogen antagonists
Past 18-24mon- surgery

21-45 for first 3yrs
21-35 after
Lasts 7 days or less
6 or fewer pads/tampons

203
Q

What type of abnormal cycle needs further eval?

What are the two types of Amenorrhea

What are the 3 caveats

A

2 or more abnormal cycles or skipped period for more than 3 consecutive cycles

Primary- 15y/o or no period 3yrs after puberty onset
Secondary- no menstruation for 3 cycles in post-menarchal PT

Lacks puberty signs by 13
Sexually active
Early breast development

204
Q

What are the first line evaluations for amenorrhea?

What are the S/Sxs of PCOS

A

TSH, Prolactin, FSH, HCG, US if primary

Hperandrogenism, obesity, insulin resistance

205
Q

PCOS can be Dx with two of what findings?

A

Infrequent bleeding
Secondary amenorrhea
Hyperandrogenism
US showing morphology

206
Q

How is PCOS anovulation manages?

How is hypothalamic amenorrhea treated?

A

Cyclic Prog/PO OCs

Est/prog combo

207
Q

What drugs are used for androgen excess in PCOS PTs?

What is the most common cause of abnormal uterine bleeding in adolescents?

A

Combo Est/Prog
Sprinolactone helps hirsutism
Metformin

Anovulation

208
Q

Why are combo Est/Prog used for abnormal uterine bleeding cases?

A

Regulates menstruation
Allow hypothalamic-pituitary-gonad axis maturity
Pts w/ bleeding d/o (Von Willebrand)

209
Q

What causes the pain of 1* Dysmenorrhea

A

Prostaglandins/Leukotriens from declining progesterone levels increase uterine tone and contractions

210
Q

Menstruation pain w/ pelvic pathology is most frequently caused by ?

If outlet obstruction is suspected, what imaging is used?

A

Endometriosis or PID

US

211
Q

When are MRIs used for dysmenorrhea evals?

How is endometriosis Dx?

A

Complex reproductive tract abnormalities

Laparoscopy
PID in Tx failure

212
Q

What are the red flags of Enometriosis/Adenomyosis, Mullerian, and PID

A

E/Ad- increasing dsymenorrhea despite therapy
M= pain at/shortly after menses w/ known renal tract abnormality
PID- vaginal d/c

213
Q

How is dysmenorrhea treated?

A

Prevent/dec prostaglandins w/ NSAIDs
If unsuccessful, hormones
If hormones fail after 4mon, re-eval and reconsider Dx

214
Q

Sex identity is self perceived with what 4 components

Define Gender Identity

A

Sex at birth, Gender Identity, Expression, Orientation

Basic sense of man/woman (PRESENTATION)

215
Q

Define Gender Expression

Define Gender Non-Conforming

A

Characteristics, need to distinguish from gender identity

Fem boy/masculine girl

216
Q

Define sexual orientation

Define Sexual behavior

A

Attraction/attachments to men/women

Activity for pleasure

217
Q

What is the difference between trans, cross dresser and drag?

A

Trans- live in other gender
Cross- crosses over but reverts back to assigned
Drag- impersonator

218
Q

Define nonbinary

Define Gender Fluid

A

Neither

Not fixed but changing

219
Q

When is gender identity formed?

Whats the difference between Gender Constancy and Consistency

A

2-3yrs

Const- stable over time
Consis- permanent

220
Q

What part of gender identity is normal and part of life?

Define Gender Dysphoria

A

Nonconformity

Distress from inconsistency on thoughts/feelings of gender
More often in male kids but even in adolescence

221
Q

Can medical professionals tell coaches a Ped PT isn’t cleared for sports and not violate HIPPA?

What two cardiac findings during sports physicals are bad?

A

Yes, but can’t tell why

Murmur that gets louder w/ Valsalva or standin

222
Q

Can kids play sports with seizure history?

What is a disqualifier?

A

Yes as long as it’s controlled

Stage 2 HTN or poorly controoled (S/DP >99 percentile for age +5mmHg)

223
Q

Can kids play sports w/ Mono?

How many calories do male/female adolescents need?

A

Restricted for 28 days to dec risk of spleen trauma

F: 1800-2400
M: 2000-3200

224
Q

What is the Ca+ requirement for adolescents

How is adolescent BMI calculated?
What is over, obese

A

1300mg/day

BMI= kgs/height in meters^2
>120% IBW obese
>200 IBW morbid
85-95% BMI= overweight
>95% BMI= obese
225
Q

Define SCFE

Define Blount’s Dz

A

Most common hip d/o in obese PTs when rapid femur growth weakens plate and causes slipage backward off of epiphysis

Growth issue causing tibia to angle inward

226
Q

Define NASH

What is the SMART acronym for obesity?

A

Non-Alcoholic Steatohepatitis
Severe form of fatty liver

Specific
Measurable
Achievable
Relevant
Timely
227
Q

What are diet goals for Peds at 7y/o

A

<7- maintain weight, let linear growth catch up

>7= 1lb/mon until <85% BMI

228
Q

What appears first, anorexia or bulemia?

What neonatal sign may be seen in anorexia?

A

Anorexia, bulemia presents w/ BPD/o

Lanugo

229
Q

How is Anorexia treated?

When do they need to be hospitalized?

A

Feeding program to restore weight

>25% loss of ideal weight
Suicide risk
Bradycardia/Hypothermia
Dehydrate/hypo-K/dysarrhythmia
Failed OutPT
230
Q

Dx criteria for bulemia

How is it treated?

A 
2x/wk x 3mon
Discrete eating
Loss of control
Compensatory over reactions
Self eval of unwanted size

Anti-Depressants

231
Q

Define Female Athelete Triad

What happens to the brain during this d/o

A

Too much exercise dec estrogen
Attempted weight loss to inc performance
Low bone density, inc Fx risk

BF% dec and stops hypothal/pit/gonad system

232
Q

What meds can be used for Female Athlete Triad

What is the SIGECAPS acronym for Dep/Suicide

A

OCPs to restore menses, won’t correct bone loss
Ca, K Vit D supplements
Mainstay= life modification

Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Safety/Suicide

233
Q

What is a leading cause of death in teens that surpasses MVAs?

What med is used for depressed/suicidal adolescents?

A

Suicide

Fluoxetine or Escitalopram
Risk- SSRIs, inc suicide risk

234
Q

Define Anxiety

What is the difference between Anxiety and anxiety d/o

A

Dread or Apprehension

Anxiety= not pathologic
D/o= pathologic, most common psych d/o of childhood
235
Q

When does Separation Anxiety D/o develop

A

10-18mon

By age 3, can accept temporary absence

236
Q

When does Schizo frquency increase?

What are the 4 Sx categories for Schizo?

A

13-18y/o
Higher risk in monozygotic twins (identical) and 1* relatives

Pos Sxs= hallucinations and delusions
Neg Sxs= lack of motivation/social interaction
Disorganization of thought/behavior
Cognitive impairment- most common/disabling

237
Q

What are the 5 sub-types of Schizo

A

Paranoid- delusion persecutory
Disorganized
Catatonic- rare in kids/adolescents
Undifferentiated- doesn’t fit other types
Residual- previous Dx, no current Pos Sxs

238
Q

What is the Substance Abuse Screening acronym

A

CRAFT

Car, Relax, Alone, Forgetting, Fam/Friends, Trouble

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