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Clinical Medicine I > Pediatrics Exam I > Flashcards

Pediatrics Exam I Flashcards

1
Q

Hepatitis B

A
  1. Name: HBV
  2. Series of 3: Birth, 1-2 mos, 6-18 mos
  3. Contraindications:
    - life threatening allergy to yeast
    - allergy to vaccine,
    - moderate to severe illness
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2
Q

Diptheria, tetanus, acellular pertussis

A
  1. Name: DTaP
  2. Series of 5: 2mo, 4 mo, 6 mo, 15-18 mo, 4-6 yrs
  3. Contraindication:
    - encephalopathy w/ in 7 days of vaccine
    - Allergy
    - moderate to severe illness
  4. Precaution: unstable neuro disorder
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3
Q

Haemophilus influenzae type B

A
  1. Name: Hib
  2. 2 or 3 shot series + booster: 2 mo, 4mo, 6 mo, 12-15 mo (booster)
  3. Contraindication:
    - age less than 6 weeks
    - severe latex rxn
    - allergy to vaccine
    - moderate to severe illness
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4
Q

Inactivated poliovirus

A
  1. Name: IPV
  2. 4 shot series: 2mo, 4 mo, 6-18mo, 4-6 yrs
  3. Contraindications:
    - anaphlactic rxn to neomycin, streptomycin, polmyxin B
    - allergy to vaccine
    - moderate to severe illness
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5
Q

Pneumococcal conjugate (PCV 13)

A
  1. Name: PCV 13

2. 4 shot series: 2 mo, 4 mo, 6 mo, 12-15 mo

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6
Q

PPSV23

A
  1. High risk kids 2 years or older
  2. PCV 13 + PPSV23
  3. Protects against 23 types of pneumococcal bacteria
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7
Q

Strep. Pneumoniae

A

leading cause of bacterial meningitis in US children.

200 children die each year

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8
Q

Rotaviris

A

LIVE-ATTENUATED

  1. Name: Rotarix, RotaTeq
  2. Rotarix (2 shot), RotaTeq (3 Shot): 2 mo, 4 mo, 6 mo
  3. Contraindications
    - Severe combined immunodeficiency
  • in-utero exposure to immunomodulating agents
  • Rotarix: severe latex allergy
  • history of intussusception
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9
Q

Hepatitis A Vaccine

A
  1. Name: HAV
  2. 2 shot series: 12-23 mos, 2nd dose w/in 6 to 18 mos
  3. Contraindications:
    - severe allergy to prior dose or vaccine additives
  4. AZ high risk: dose 1 required 15 days prior to enrollment at child care, preschool or headstart
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10
Q

Measles, Mumps, Rubella

A

LIVE VACCINE

  1. Name: MMR
  2. 2 shot series: 12-15 mo, 4-6 years
  3. Contraindications:
    - anaphylactic rxn to neomycin or gelatin
  • Pregnancy
  • immunosuppression
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11
Q

Varicella

A

LIVE VACCINE

  1. Name: Varicella
  2. 2 Shot series: 12-15 mo, 4-6 years
  3. Contraindications:
    - anaphylactic rxn to neomycin or gelatin
  • severe immunosuppression
  • pregnancy
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12
Q

MMR + Varicella

A

LIVE VACCINE

  1. MMRV
  2. 2 Shot series: 12-15 mo, 4-6 years
  3. Contraindications:
    - anaphylaxis after previous dose
    - immunosuppression
    - Pregnancy
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13
Q

Quadrivalent Meningococcal Polysaccharide Vaccine

A
  1. Names: Menactra, Menveo
  2. 2 Shot series: 11-12 yrs, 16 yrs
  3. High risk age <11 or age > 18
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14
Q

Serogroup B Meningococcal Bexsero Trumenba

A
  1. Name: MenB
  2. 2 or 3 shot series: 16-23 yers old
  3. 10 or older who are at increased risk for serogroup B meningococcal disease
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15
Q

HPV Vaccine

A
  1. Name: Gardasil
  2. Typically 2 shot series: 0 and 6-12 months
  3. 11-12 yrs old
    - 9-26 in females, 9-21 in males
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16
Q

Inactivated Influenza Vaccine

A
  1. IIV, flu shot
  2. indicated annually for everyone 6 mos and older
  3. Children 6mos-8yrs require 2 doses 4 wks apart during first season
  4. Contraindications:
    - severe allergy to an influenza vaccine
  5. Precaution: Guillan Barre w/in 6 weeks of vaccination
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17
Q

Intranasal Influenza Vaccine

A

LIVE VACCINE

  1. Name: FluMist
  2. ages 2 or older, younger than 50
  3. Contraindications
    - Pregnancy
  • Hypersensitivity to vaccine or components
  • aspirin therapy in children and adolescents (risk of Reye’s Syndrome
  • immunocompromised
  • age 2-4 w/ wheezing episode in last 12 mo
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18
Q

Common side effects

A
  1. fussiness
  2. drowsiness
  3. low-grade fever
  4. pain, redness, swelling at site of injection
  5. loss of appetite
  6. myalgias
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19
Q

Uncommon side effects

A
  1. anyphylaxis
  2. seizures
  3. inconsolable crying for greater than 3 hours
  4. fever greater than 105
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20
Q

Persistance of primitive reflexes

A

sign of neurodevelopmental disorders

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21
Q

Absense of primitive reflexes

A

disordered cerebral function

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22
Q

Growth Measurements under 2 yo

A

length
weight
head circumfrance

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23
Q

growth over 2 yo

A

BMI
height
weight
head circumference

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24
Q

Measuring height

A
  1. 0-2: measured in supine position, plot on standard growth chart
  2. over 2: standing, plot on standard growth chart
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25
Q

Measuring weight

A

weight in clean diaper

over 3, without shoes

between 5th and 85th percentiles is normal

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26
Q

Calculating BMI

A

(weight/stature^2) x 703

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27
Q

Head Circumference

A
  1. 0-3 years
  2. neurologic abnormalities and malnutrition
  3. should correlate w/ child’s length (percentiles should match)
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28
Q

Abnormal head size

A
  1. assess pattern of head growth
  2. compare w/ other growth parameters
  3. look for dysmorphic features
  4. neuro/developmental assessment
  5. signs and sx of increased intracranial pressure
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29
Q

Failure to Thrive Definition

A
  1. drop of 2 or more major percentile line on standardized growth chart
  2. height or weight drops below 3rd percentile on standardized growth chart
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30
Q

Hx of FTT

A
  1. Early infancy: onset 4-6 months due to underfeeding or HIV, reflux, CHD, CF
  2. Later infancy: onset 7-9 months due to food intolerances/diarrhea, battle of spoons
  3. Todder: slower weight gain, control issues, developmental issues, distraction
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31
Q

FTT Labs

A 
CBC
lead screen
stool culture
UA
Urine Culture
CMP
PPD/Quanteferon
Hemacult
Metabolic Screening
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32
Q

Common FTT problems

A
  1. dilution of formula
  2. excessive intake of juice or water
  3. infrequent feeding
  4. no set feeding times
  5. no high chair
  6. distractions
  7. control issues
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33
Q

FTT Tx

A

Multidisciplinary

  1. trial of nutritional therapies
  2. Referrals to OT/GI
  3. Nutritionist/RD
  4. Hospitalization
  5. Close f/u
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34
Q

Peds BP

A
  1. HTN = systolic/diastolic BP 95th percentile or over on 3 or more occasions
  2. annual screening begins at 3 yp
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35
Q

H & P: Neck Red Flags

A

painful, unilateral solitary adenopathy > 2cm

weight loss

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36
Q

H & P: Throat

A

Tonsils enlarged compared to other anatomy

tendency to get pharyngitits

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37
Q

H & P: Chest and Lungs

A

Ascultate through crying

Asthma in peds population

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38
Q

H & P: Cardiac exam

A

PMI at 4th intercostal until 7, then 5th

PMI to left of MCL at 4, MCL at 5-6, Right of MCL at 7

50% of children have innocent murmor during childhood

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39
Q

H & P: Abdomen

A

protuberant until adolescence

facial expression during palpation

Sports physical: presence of kidney is contraindication

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40
Q

H & P: GU

A

inguinal hernia in males with sports or weight lifting

pelvic exam when females become sexually active

Tanner sexual maturity rating to note development of secondary sexual characteristics

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41
Q

Vision screening

A

red light reflex, EOMs, inspection, pupil symmetry and reactivity

Fundoscopic and visual acuity beginning at 3 yo

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42
Q

Hearing Screening

A

infant at 1 mo

Formal hearing 4,5,6,8 and 10

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43
Q

Cholesterol and Lipids

A

screening for BMI > 85th percentile

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44
Q

Lead screening

A
  1. high risk

2. peak levels 18-24 mo

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45
Q

Iron-Deficiency Anemia

A
  1. 8% of all 1-3yo children
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46
Q

Dental screening

A

1-4 yo

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47
Q

SIDS

A

leading cause of infant mortality between 1 mo and 1 year

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48
Q

Colic

A
  1. Onset: 2-3 weeks old
  2. Resolves around 12 weeks
  3. Rule of 3s: 3hrs of crying, 3 days a week, for 3 weeks
  4. infants pull knees up, clench fists, want constant movement
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49
Q

Causes of colic

A

overload, immature digestion, environment, parental tension

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50
Q

Tx of Colic

A
  1. cope calmly
  2. gas medications
  3. take breaks
  4. soothing positions and noises
  5. colic formulas
  6. reflux meds: raniditine
  7. reassurance
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51
Q

Neonate

A

first 28 days of life

52
Q

infant

A

29 days to 12 months

53
Q

preemie

A

birth before 37 weeks

54
Q

APGAR

A
  1. taken at 1 and 5 minutes, from 0-10

Activity:
0-absent
1-arms and legs flexed
2- active movement

Pulse:
0- absent
1- below 100 bpm
2- over 100 bpm

Grimace:
0-flaccid
1- some flexion of extremities
2- active motion (cough, sneeze, pull away)

Appearance:
0-blue, pale
1- body pink, extremity cyanosis
2-completely pink

Respiration:
0-absent
1- slow, irregular
2- vigorous cry

0-3 severely depressed

4-6 moderately depressed

7-10 excellent condition

55
Q

APGAR Interventions @ 1 minute

A

<4: resuscitation

5-6: some nervous system depression

7-10: normal

56
Q

APGAR Interventions @ 5 minutes

A

6 or under: high risk for CNS/organ dysfunction

7 or greater: proceed to thorough exam

57
Q

Transitional period assessments

A

4-6 hours, Assess every 30-60 minutes

  1. HR: 120-160 bpm
    2: Resps: 40-60
  2. Temp: 36.5-37.5 (9.7-99.5)
  3. Color: central cyanosis
  4. Tone
58
Q

Ballard Scoring System

A

Estimate gestational age within 2 weeks

Assessment of neuromuscular and physical maturity

59
Q

Gestational Ages

A

Preterm < 34 weeks

Late-Preterm 34-36 weeks

Term 37-42 weeks

Postterm > 42 weeks

60
Q

Birth weight classification

A

extremely low < 1000g

Very low < 1500g

Low < 2500 g

Normal 2500g or more

61
Q

Care of the well neonate

A
  1. prophylactic erythromycin ophthalmic ointment (gonococcal ophthalmia)
  2. vitamin K (1.0 mg) IM
  3. Hep B Vaccine
  4. umbilical cord care
  5. monitor for hyperbilirubinemia and hymoglycemia
  6. Newborn screen: heel stick, pulse ox, hearing screen
  7. supine position
62
Q

Newborn screen:

A

heel stick done at 24-48 hours, and at first doctor’s visit or 5-10 days age

  1. endocrine disorders
  2. organic acid disorders
  3. fatty acid oxidation disorders
  4. hemoglobin disorders
  5. enzyme deficiencies
  6. amino acid disorders
  7. CF
63
Q

Congenital hypothyroidism

A
  1. common preventable cause of mental redardation
  2. 95% asymptomatic at birth
  3. 85% thyroid dysgenesis
64
Q

Adrenal hyperplasia

A

Females: ambiguous genitalia w/ glitoral enlargement and urethral/vaginal orifice. normal female organs

Males: no overt signs. Salt losing crisis. Non salt losing: signs of puberty in toddlers

65
Q

Sickle Cell acute manifestations

A
  1. infection
  2. anemia
  3. vaso-occlusive pain
  4. stroke
  5. acute chest syndrome
  6. renal infarction, medication toxicity
  7. MI
  8. thromboembolism
66
Q

Sickle Cell Chronic Manifestations

A
  1. pain
  2. anemia
  3. neuro deficit
  4. renal impairment
  5. HTN
  6. cardiomyopathy w/ diastolic dysfunction
  7. hepatic injury
  8. delayed puberty and reduced growth
  9. chronic leg ulcers and proliferative retinopathy
67
Q

CF

A
  1. 80-90% of newborns w/ meconium ileus have CF

2. sweat chloride test is most important diagnostic test, done in f/u to positive newborn screen.

68
Q

Hearing scren

A
  1. ABR (auditory brainstem reponses)
  2. OAE (otoacoustic emissions)
    - sound generated from inner ear
    - determines cochlear status/hair cell fxn
69
Q

Positive Pulse Ox

A
  1. SpO2 of < 90% in either extremity
  2. SpO2 of 90-94% in both upper and lower extremities on 3 measurements separated by an hour
  3. SpO2 difference > 3% between upper and lower extremities on 3 measurements separated by 1 hour
70
Q

Infant feeding

A
  1. fed 8-12 times/24 hours for 10-15 minutes
  2. vitamin D supplement after birth
  3. formula should be standard 20kcal/oz w/ fe
71
Q

Skin/Hair assessment of neonate

A
  1. vernix casosa
  2. texture
  3. color: jaundice, cyanosis, meconium staining
  4. skin eruptions/rashes
  5. birth marks/vascular markings
  6. lanugo
  7. midline hair tufts
72
Q

lanugo

A

fine, depigmented hair covering neonate

73
Q

milia

A
  1. smooth white pinpoint papules on nose and cheeks
  2. retention of keratin and sebaceous material
  3. appear w/in first few weeks, disappears over several
74
Q

Neonatal acne

A
  1. 20% of infants
  2. multiple papules and pustules
  3. primarily affects forehead, cheeks, upper chest
  4. starts 2-3 weeks
  5. resolves 4-6 months
75
Q

Miliaria rubra

A
  1. scattered vesicles on erythematous base on face, neck, frunk.
  2. non-follicular
  3. obstruction of sweat glands, heat rash
  4. disappears spontaneously
76
Q

Erythema toxicum

A
  1. appears days 2 or 3
  2. 31-72% term neonates
  3. erythematous macules with central pinpoint vesicles
  4. progress to pustules, scatter diffusely
  5. disappear w/in 1 week of birth
77
Q

Pustular melanosis

A
  1. more common in black infants
  2. 3 stages, superficial white pustules, unroom erythematous macules w/ surrounding scale, hyperpigmented macules that gradually fade
78
Q

Acrocyanosis

A
  1. Bluish discoloration on hands and feet common after birth.
  2. mucosa remains pink
  3. differentiate from central cyanosis
79
Q

Severe neonatal hyperbilirubinemia

A
  1. TB > 25mg/dl
  2. neurotoxic
  3. preemie high risk
  4. bilirubin-induced neurologic dysfunction (BIND) risk
80
Q

Tx of neonatal jaundice

A

phototherapy

81
Q

Jaundice pearls

A
  1. w/in 24 hrs is pathologic
  2. starts after 2 weeks is pathologic
  3. ABO or Rh incompatibility
  4. early discharge needs 2 day f/u
82
Q

Cephalohematoma

A

associated w/ forceps or vacuum delivery

resolves spontaneously w/in 3 weeks

83
Q

positional plagiocephaly

A

flattening of parieto-occipital region.

Positional changes angle of face, synostotic doesn’t

84
Q

Eye examination

A
  1. Visual milestones: birth- blinks, regards a face. 1 mo - fixes on an object
  2. inspect sclerae, pupils, irises, EOMs
  3. Nystagmus common immediately after birth
  4. intermittent strabismus normal w/in first few months of life
85
Q

Red flags for fundoscopic exam

A
  1. dark spots
  2. unilateral blunted red reflex
  3. absent reflex
  4. white pupillary reflex
  5. cloudiness of cornea
86
Q

Acoustic blink reflex

A

blinking when fingers snapped 12 in from ear

87
Q

Ear exam red flags

A

small deformed or low set auricles indicate potential renal defects

88
Q

Choanal atresia

A

congenital narrowing of the back of the nasal cavity that causes difficulty breathing

89
Q

Epstin’s pearls

A

small, white benign inclusion cysts

commonly clustered at midpoint of junction btwn soft and hard palate

90
Q

Torticollis

A

position/injury to SCM, precipitating factor of plagiocephaly

91
Q

Omphalitis

A

infection of umbilical stump

92
Q

cryptorchidism

A

undescended testicle.

2/3 descend by 1 year

93
Q

hypospadias

A

urethral opening at inferior aspect of glans penis

94
Q

hydrocele

A

swelling of scrotom w/ fluid accumulation

95
Q

Rectal exam of neonate

A

cannot happen until meconium is passed. usually by 48 hours

96
Q

Galeazzi Test

A
  1. Test for hip dysplasia
  2. feet together, not difference in knee height
  3. unequeal knee height = positive
97
Q

Barlow Test

A
  1. ability to sublux or dislocate an intact but unstable hip
98
Q

Ortolani test

A
  1. test for the presence of posteriorly dislocated hip
99
Q

Positive babinski

A

dorsiflexion of big tow and fanning of other toes

100
Q

CN V test

A

rooting/sucking reflex

101
Q

CN VIII test

A

acoustic blink reflex

102
Q

Rooting reflex

A
  1. Birth to 3-4 months
  2. stroke perioral skin at corners of mouth
  3. mouth should open and baby turn head toward stimulated side and suck
103
Q

Moro reflex

A
  1. Startle Reflex
  2. Birth to 5-6 months
  3. hold baby supine, support head, back and legs
  4. abruptly lower entire body 2 ft.
  5. arms abduct, extend, hands open, legs flex
104
Q

Palmar grasp

A
  1. Birth to 4-6 mo
  2. place fingers into baby’s hands and press against palmar surfaces
  3. baby will grasp fingers
105
Q

Plantar grasp

A
  1. Birth to 6-8 mo
  2. touch sole at base of toes
  3. toes curl
106
Q

Asymmetric tonic neck reflex

A
  1. birth to 2-3 mo
  2. with baby supine, turn head to one side, hold jaw over shoulder
  3. arms/legs on side which head is flexed should extend, while opposite flex
107
Q

Positive support reflex

A
  1. birth or 2 mo - 6 mo
  2. hold baby around the trunk and lower until feed touch flat surface
  3. hips, knees, ankles extend, baby stands up
  4. partial weight bearing, sag after 20-30 seconds
108
Q

Developmental screening

A
  1. Screening at 9, 18, and 24 or 30 mo
  2. autism specific screening at 18 and 24/30 mo
  3. Parent report is reliable
109
Q

Red flags for autism

A
  1. 12 mo: no babbling, pointing or gestures
  2. 16 mo: no single words
  3. 24 mo: no 2 word phrases
  4. any age: loss of language, social or other skills
110
Q

2 months milestones

A
  1. Physical: lift and turn head, track past midline, primitive reflexes present
  2. Language: turns head toward sound
  3. Cognitive: alert to voices, follow objects w/ eyes
  4. Social/emotional: begins to responsively smile
111
Q

Anticipatory guidance 2 mos

A

sleep on back, SIDS education. Most common cause of death 2-4 mo

112
Q

4 months milestones

A
  1. Physical: holds head steady, rolls stomach to back
  2. language: laughs and squeals
  3. Cognitive: follows moving objects side to side
  4. Social: enjoys play w/ ppl, copies movements
113
Q

Anticipatory guidance 4 mos

A

tummy time. regular sleep and feeding schedule. risk of 2nd hand smoke

114
Q

6 months developmental milestones

A

Physical: sits unsupported, reaches for object and brings to mouth, rolls over both ways

Language: vowel and consonant sounds, responds to sounds

Cognitive: brings objects to mouth

Social: responds to other’s emotions

115
Q

Anticipatory guidance 6 mos

A

feed solids, don’t add sugar or salt.

put baby to sleep awake but drowsy

116
Q

9 months developmental milestones

A
  1. Physical: crawling, pull to stand, stand holding on
  2. Language: starts saying mama, baba, dada w/out meaning. understands “no”
  3. Cognitive: peek-a-boo, object permanence
  4. Social: stranger fear first develops
117
Q

12 month developmental milestones

A
  1. Physical: takes steps, stands alone (2 sec)
  2. Language: simple gestures, “mama” “Dada” w/ meaning. 2 word vocab. responds to verbal commands
  3. Cognitive: copies gestures
  4. Social: cries when parents leave
118
Q

15 month developmental milestones

A
  1. Physical: walks well, stoops down
  2. language: 4-5+ word vocabulary. Red flag no single words
  3. Social: hands things to others to initiate play
  4. Cognitive: knows purpose of ordinary things and attempts to use them
119
Q

18 month developmental milestones

A
  1. Physical: run. kick a ball. eat w/ spoon and feed self
  2. language: 20-50 word vocabulary
  3. Social: looks for help when in trouble.
  4. Cognitive: improved function w/ ordinary items
120
Q

Anticipatory guidance

A

Potty training: await readiness. may introduce potty chair

by 2-4 years daytime control achieved

by 5-7 nighttime control expected

121
Q

24 months developmental milestones

A
  1. Physical: throws ball overhand, stands on tip toes
  2. Language: Speaks in short phrases, 2 words or more. Repeats overheard words
  3. Social: Helps undress and put items away. Empathy develops
  4. Cognitive: completes familiar sentences and rhymes. might use 1 hand more than another
122
Q

36 month developmental milestones

A
  1. Physical: stands on one foot
  2. Language: understandable 50% of the time, speaking in sentences
  3. Social: pretend play and simple games
  4. cognitive: make believe play
123
Q

School age, 6-12, development

A
  1. Language: 5-7 word sentences, 5 step commands by age 10.

2. Cognitive: improved focus, should be able to handle a task for at least 15 minutes

124
Q

Immunization schedule mneumonic

A

B

2 B DR HIP

4 DR HIP

B DR HIP IN 6 Mo

1 MAD HPV

VERY DIM between 4-6pm

Tada! Human Men!

125
Q

Live virus vaccines

A

MMR, FluMist, Varicella, Rotavirus

Clinical Medicine I (25 decks)

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