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ANCC - Fitzgerald Notecards > Pediatrics: School-Age Children > Flashcards

Pediatrics: School-Age Children Flashcards

1
Q

Danger Signals! Kawasaki Disease/Syndrome

A
  • Onset of high fever (up to 104.0º F) for ≥ 5 days

Presence of at least 4 of the following clinical signs:
- enlarged lymph nodes in neck
- bright-red rash (more obvious on groin area)
- bilateral conjunctivitis (dry, no discharge)
- oral mucosal changes (e.g., dry cracked lips, “strawberry tongue”)
- swollen hands/feet

After fever subsides, skin peels off hands and feet

Tx:
- high-dose aspirin
- IV gamma globulin

  • ~75% of cases occur in children <5 yo
  • resolves within 1-3 weeks
  • may have serious sequelae: aortic dissection, dilation or aneurysms of coronary arteries, and hearing loss
  • requires close follow-up w/ p[ediatric cardiologist for several years d/t effects may not be apparent until child is older (or an adult)
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2
Q

Danger Signals! Leukemia

A
  • c/o extreme fatigue and weakness
  • pale skin
  • easy bruising
  • may have petechial bleeding (pinpoint to small red spots)
  • may have bleeding gums/nosebleeds
  • some have bone/joint pain
  • lymphadenopathy
  • abdominal swelling
  • Most common type of CA in children/adolescents
  • most common type: ALL
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3
Q

Danger Signals! Acute Lymphocytic Leukemia (ALL)

A
  • most common form of leukemia in childhood (75%)
  • fast-growing CA of the lymphoblasts, which are immature lymphocytes
  • peak occurrence at 2-4 years
  • CBC will show very HIGH WBC (>50,000 cells/mm3)
  • girls have higher chance of cure
  • African Americans, Hispanic children tend to have lower cure rate compared to other races
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4
Q

Danger Signals! Acute Myelogenous Leukemia (AML)

A
  • fast-growing CA of bone marrow, affecting immature or precursor blood cells such as myeloblasts (WBCs), monoblasts (macrophages, monocytes), erythroblasts (RBCs), megakaryoblasts (platelets)
  • Children w/ Down syndrome who have AML tend to have better cure rates, esp; if child is <4 years
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5
Q

Danger Signals! Reye’s Syndrome

Clinical Staging: Mild to Moderate, Severe

A
  • Hx of febrile viral illness (chickenpox, influenza) and aspirin or salicylate intake (e.g., Pepto-Bismol) in child
  • Theoretical risk of Reye’s syndrome after varicella immunization
  • Avoid using aspiring before, during, and after immunization
  • Abrupt onset w/ quick progression
  • death can occur within a few hrs to a few days
  • mortality rate up to 52%
  • Although most cases are in children, teenagers and adults may be diagnosed; disease is now rare

Mild to Moderate
* Stage 1
- Severe vomiting
- lethargic/sleepy
- elevated ALT and AST

  • Stage 2
  • deeply lethargic
  • restless
  • confused/delirious/combative
  • hyperactive reflexes
  • hyperventilation
  • Stage 3
  • obtunded or in light coma
  • decorticate rigidity

Severe
* Stage 4
- Coma
- seizure
- decerebrate rigidity
- fixed pupils
- loss of reflexes

  • Stage 5
  • Seizures
  • deep coma
  • flaccid paralysis
  • absent DTRs
  • respiratory arrest
  • death
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6
Q

Down Syndrome: Atlantoaxial Instability

A
  • Up to 15% of Down Syndrome pts have atlantoaxial instability
  • Medical clearance is recommended for some sports participation
  • children/adolescents (or older) w/ Dwon syndrome who want to participate in sports sneed cervical spine x-rays (including lateral view)
  • pts w/ atlantoxial instability are restricted from playing contact sports 9e.g., basketball, tackle football, soccer) and other high-risk activities (e.g., trampoline jumping)
  • persons w/ Down syndrome w/out evidence of atlantoaxial instability may participate in low-impact sports and sports not requiring extreme balance
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7
Q

atlantoaxial instability

A

excessive mobility at the articulation of C1 and C2)

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8
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Hypertrophic Cardiomyopathy

A
  • Risk of sudden cardiac death w/ intense exercise
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9
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Atlantoaxial instability (Down syndrome, juvenile RA)

A
  • Instability b/w C1 and C2 can cause spinal cord compression
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10
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Marfan syndrome

A
  • Risk of aortic aneurysm and cardiac death
  • lens eyes displacement
  • joint hypermobility
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11
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Ehlers-Danlos syndrome (Vascular form)

A
  • risk of cerebral or cervical artery aneurysm
  • spondylolisthesis
  • joint hypermobility
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12
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Acute rheumatic fever w/ carditis

A
  • Worsens condition
  • heart inflamed
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13
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Mitral Valve prolapse, esp if significant MV pathology

A
  • risk of sudden cardiac death
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14
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Fever

A
  • Risk of heart illness, hypotension, and ↑ cardiopulmonary effort
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15
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Infectious diarrhea

A
  • risk of dehydration and heat illness; contagious
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16
Q

Medical Conditions that May Disqualify Youth From Sports Participation + Rationale: Pink Eye

A
  • contagious
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17
Q

Absence Seizures

A
  • brief episodes during which child suddenly stops whatever they are doing and stares
  • if in school, teacher may tell parent that child is daydreaming and inattentive
  • common type of pediatric seizure
  • AKA: petit mal seizure

First-line therapy: ethosuximide
→ Refer to pediatric neurologist

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18
Q

Still’s Murmur

A
  • benign systolic murmur, described as having a vibratory or musical quality
  • becomes louder in supine position or w/ fever
  • minimal radiation
  • Grade I/II intensity
  • most common in school-age children
  • usually resolves by adolescence
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19
Q

US Health Statistics: School-Age Children
Top Causes of Death: Age 5-9 years (Early school age)

A
  • Malignant neoplasms
  • MVA
  • Congenital abnormalities
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20
Q

Immunizations: Preschool Children (age 4-6 years)

A

Administer vaccines:
- MMR
- varicella
- IPV
- DTaP

If hx of chickenpox documented in chart, do not need varicelle

21
Q

Immunizations: School-Age Children (age 7-12 years)

A
  • If 7-9 years w/ incompleted immunization record for DTaP, give Tdap as first catch-up dose; followed by tetanus-diphtheria (Td) vaccine)
  • Tdap booster should be administered to all 11-12 years (regardless of whether it was used in catch-up schedule)

Most common “middle school” vaccines at 11-12 years are:
- Tdap
- meningococcal conjugate vaccine (MCV4; Menacdtra or Menveo)
- HPV vaccine (Gardasil)
- HPV vaccine can be administered as young as 9 years

  • HPV vaccine is recommended for both and girls; Gardasil is used for both genders
    → If first dose of HPV given b/w 9-14 years, ONLY 2 doses are needed; 3 doses needed if series started at ≥ 15 years

Age 13-14 (or older): give Tdap if did not receive at 11-12 years

If no hx of varicella immunization or disease, give varicella vaccine

  • If child did not complete Hep A/B series, administer next dose and resume interval dosing; Do NOT restarted Hep A/B series
22
Q

Meningococcal Vaccines

A

6 types of menogo0coccal vaccines; only 2 are discussed here
- MenACWY-D (Menactra): Youngest age is 9 months
- MenACWY-CRM (Menveo): Youngest age is 2 months

  • Administer Menactra/Menveo vaccine 1st dose at 11-12 years; if missing, catch-u0p age is 13-15 years; booster (2nd dose) at 16-18 years
  • Also used for high-risk children w/ asplenia, functional asplenia (sickle cell), splenectomy, HIV infection, and complement deficiencies
  • All 11-12 years should be vaccinated w/ single dose of quadrivalent meningococcal vaccine (MenACWY); brand names are Menactra and Menveo
23
Q

Primary Series of Vaccination: Missing or Not Done after 7th Birthday (Never been vaccinated)

A

Tetanus (3 doses):
- First dose should be Tdap
- then subsequent 2 doses should be given as TRd (repeat Td Q10 years)

  • IPV (3 doses)
  • Hep B (3 doses)
  • Hep A (2 doses)
  • MMR (2 doses)
  • Varicella (2 doses) if no hx of chickenpox
  • HPV (2-3 doses based on age given; administer of <26 years)
24
Q

Routine and Catch-Up Immunizations: ≥7 years - Hepatitis B

A

Total of 3 doses over 6 months
- If missing booster, give until total of 3 doses
- Do NOT repeat series

25
Q

Routine and Catch-Up Immunizations: ≥7 years - MMR

A
  • Give 2nd dose (if needs to catch up)
  • Live virus precautions
26
Q

Routine and Catch-Up Immunizations: ≥7 years - Varicella

A

Give 2nd dose (if needs to catch up) if no proof of varicella
- Live virus precautions

27
Q

Routine and Catch-Up Immunizations: ≥7 years - Hepatitis A

A

Give 2nd dose (if needs to catch up)
- recommended for children w/ certain health or lifestyle conditions placing them at risk

28
Q

Routine and Catch-Up Immunizations: ≥7 years - Influenza

A

Needed annually after 6 months

29
Q

Routine and Catch-Up Immunizations: ≥7 years - HPV

A

Give 1st dose at 11-12 years (can start at age 9)
- Catch-up dose at 13 years if missed
- Indicated for boys and girls

Initial vaccinate at 9-14 years → 2 dose series (6-12 months apart)
* HPV vaccine (Gardasil) → know that the youngest age group for vaccination is 9 years and can be given up to 26 years
→ HPV may cause CAs of the cervix, vagina, vulva, penis, anus, pharynx, and base of tongue/tonsils (oropharynx) in both men and women

Initial vaccinate at ≥ 15 years → 3-dose series (give 2nd dose 1-2 months after first; give 3rd dose 6 months after first dose)

Gardasil: can be given up tp age 26 years for high-risk patients

30
Q

Routine and Catch-Up Immunizations: ≥7 years - Meningococcal

A
  • Give 1st dose at 11-12 years
  • give booster at 16 years
  • Meningococcal conjugate vaccine (MCV4) recommended for all college freshmen living in dormitories

Vaccines needed at age 11-12 years:
- Tdap
- HPV
- MCV4

31
Q

Growth and Development: 4 years old (Preschool)
1. Fine Motor
2. Gross Motor
3. Other

A
    • mature pencil grasp
      - can copy a cross
      - draws a person w/ 3 body parts
    • rides a bicycle w/ training wheels
      - hops on both feet
      - dresses w/ little assitance
    • according to Piaget, children aged 1-4 are preoperational stage
      - ready to learn the alphabet, spell or read short words, and learn basic math concepts
32
Q

Growth and Development: 5 years old (Preschool)
1. Fine Motor
2. Gross Mother
3. Other

A
    • copies square
      - can draw a person w/ 6 body parts
      - begins to print some letters and numbers
    • can ride a bicycle (use bike helmet)
      - hops on one foot
      - can dress and undress self
    • likes to help parents w/ certain household chores
      - likes to help adults
33
Q

Growth and Development: 6 years old (Kindergarten)
1. Fine Motor
2. Gross Motor
3. Other

A
    • copies a triangle (copies a diamond at age 7)
      - ties shoes
    • climbs trees
      - skips
    • begins more formal schooling w/ instruction in basic math and reading skills
34
Q

Growth and Development: 7-11 years old (Middle Childhood)

A
  • Freud classified this age group under “latency stage”
  • major task for this age group is to succeed in school and interact w/ their peer group
  • may have a “best” friend(s)
  • some girls may start puberty at age 8
  • according to Paget, this age group is in concrete operations stage
    *- early abstract thinking starts at about 11 years (Piaget)
  • starts to think of the future
35
Q

TV and Electronics Use

A
  • Limit to 2 hours a day or less
  • use parental-control software
36
Q

Jean Piaget’s Stages of Cognitive Development

A

Sensorimotor
Age: Birth - 2 years
Goal: Object permanence

Preoperational
Age: 2-7 years
Goal: Egocentric, pretend play

Concrete opertional
Age: 7-11 years
Goal: Conservation, math, numbers

Formal operational
Age: 12 years to adulthood
Goal: Abstract thinking, logic, ethics, morals

37
Q

Autism Spectrum Disorder (ASD)
1. Definition/Etiology
2. Clinical Presentation
3. Diagnostics/Treatment

A
    • neurodevelopmental disorder affecting normal development of communication and social skills
      - exact cause is unknown
      - affects more boys than girls
      - several theories about cause, but they are unproven (thimerosal, mercury, vaccines, etc).
      - difficult to diagnose before 18 months
  2. A child..
    - extremely sensitive to noises, touch, smells, and/or textures
    - will refuse to wear tight or rough-textured clothes because they feel “itchy”
    - prefers to be alone
    - has poor eye contac
    - does not interact w/ others
    - slow-to-poor language development
    - has repeated body movements such as flapping arms
    - some may appear to be progressing normally but suddenly regress
    - l anguage, physical, and social skills disintegrate
    • Refer to psychiatrist or psychologist for testing and evaluation
      - Intensive rehabilitation needed at younger age (i.e., OT, PT, SLP)

meds:
- Risperidone (Risperdal) is an antipsychotic that is prescribed for some older patients

38
Q

Fragile X Syndrome
1. Definition/Etiology
2. Clinical Presentation
3. Diagnostics/Treatment Plan

A

1/2. - child has macrocephaly (>50th percentile for age/sex) and global developmental delays
- skills and behavior acquisition slow compared w/ peers
- hyperactive behavior or specific learning disabilities (particularly involving math and problem-solving)
- high correlation w/ autism and anxiety
- tends to avoid eye contact
- pt has a long face w/ prominent forehead, jaw, and large/protruding eyes
- large body w/ flexible flat feet

    • Rfer for molecular genetic testing
      - Refer pt to developmental pediatrician or psychiatrist/psychologist for interdisciplinary evaluation and multimodal interventions
39
Q

Hand-Foot-Mouth Disease
1. Definition/Etiology
2. Clinical Presentation
3. Diagnostics/Treatment Plan

A
    • common acute viral illness
      - mainly affecting children <10 years
      - most common cause: coxsackievirus
      - spread through direct contact w/ nasal discharge, saliva, blister fluid, or stool
      - most contagious during first week of illness
    • acute onset of fever, severe sore throat, headache, and anorexia
      - multiple small blisters appear on hands, feet, and around rectum
      - ulcers are present inside mouth, throat, tonsils, and tongue
      - child will c/o sore throat and mouth pain w/ acidic foods
    • Tx is symptomatic; self-limited illness
      - complete recovery usually within 5-7 days
      - Ibuprofen/acetaminophen for pain and fever Q4-6 hours; do NOT use aspirin
      - use salt-water gargle (1/2 teaspoon salt in one glass of warm water)
      - drink cold fluids (avoid soda, orange, or lemon juice, tomato juice)
40
Q

Childhood Rashes + Appearances: Hand-foot-mouth disease

A

multiple small blisters appear on the hands, feet, and around rectum
- small ulcers inside the mouth, throat, tonsils, and tongue

41
Q

Childhood Rashes + Appearances: Impetigo

A

“honey-colored” crusted lesions
- fragile bullae (bullous type)

42
Q

Childhood Rashes + Appearances: Measles (Rubeola)

A

Koplik’s spot (small white papules) inside the cheeks (buccal mucosa) by the rear molars
- erythematous maculopapular rash beginning on face and spreads from head to feet, but spares palms and soles

  • Remember that Rubeola is measles!
43
Q

Childhood Rashes + Appearances: Varicella

A
  • generalized rash in different stages
  • new lesions appear daily for ~5 days

Papules → vesicles → pustules → crusts

  • pruritic
  • very contagious
44
Q

Childhood Rashes + Appearances: Scarlet Fever

A
  • “sandpaper” rash w/ sore throat
  • strawberry tongue is not specific (also seen in Kawasaki disease)
45
Q

Childhood Rashes + Appearances: Pediculosis capitis

A

Head lice
- ovoid white nits on hair hard to dislaodge
- rad papules that are very itchy and nits are initially located in hairline area behind the neck and ears

46
Q

Childhood Rashes + Appearances: Molluscum contagiosum

A
  • smooth waxlike round (dome-shaped) papules ranging in size from pinhead to the size of a pencil eraser (2-5mm)
  • central umbilication w/ white plug
47
Q

Childhood Rashes + Appearances: Scabies

A
  • maculopapular rash located in interdigital webs of hands, feet, waist, axillae, groin
  • very pruritic, esp at night
  • can resemble pimples, eczema, and insect bites
48
Q

Functional Constipation
1. Definition/Etiology
2. Criteria
3. Diagnostics

A
  • ROME IV criteria diagnosis of functional constipation in children (≥4 years; criteria are slightly different for infants and toddlers up to 4 years)
  • up to 80% of children w/ functional fecal incontinence may also have constipation
  • must meet ≥2 of the following criteria at least once per week (for at least 1 month)
    • Hx of withholding of stool
      - Hx of painful or hard BMs
      - Hx of large-diameter stools that may obstruct toilet
      - presence of large fecal mass in rectum
      - 2 or fewer defecations in toilet/week
      - at least 1 episode of fecal incontinence per week (thin fluid w/ feces that bypasses a large stool mass and leaks around it) → ask patient whether fecal soiling of underwear
  2. Plan film (x-ray) of abdomen to check for retained stool

ANCC - Fitzgerald Notecards (27 decks)

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