Pediatrics Stepup Flashcards
when is birth weight regained
by 2 weeks
when is birth weight regained
by 2 weeks
what weight is considered fialure to thrive
hoes does height increase in first year of life
50%
doubles 4 years
triples 13
greater than normal height assoc with what
familial, precocious puberty, gigantism, hyperthyroidism, klinefelter, marfan or obesity
lesser than normal height assoc with what
familial neglect turners constitutional growth delay chronic renal failure asthma CF IBD immunologic disease growth hormone deficiency hypothyroidism glucocorticoid excess kskeleteal dysplasias neoplasm
when do you meausre head circumgerence
first -3 years
growth that declines after birth
post natal onset
growth that is anormal from time of birth
prenatal
growth that is consistently low
genetic
doctor visits in 1st month
one at 2 weeks
one at 1 month
doctor visit schedule 2 mo to 2 years
2,4 and 6 months
then 9,12,15,18
then after age 2 annual visits
when is the H flu b vaccine not necessary
children >5 that were never vaccinated because low risk of infection at this age
which children should always always receive Hflu-b and pneumococcal vaccines
asplenic
when do children socially smile
2 months
when do children coo
2 months
when do children laugh
4 months
when do children have stranger anxiety
6 months
motor skills at 6 months
roll over and holds up with hands
sits without support
when do children babble
6 months
milestones of 9 month olf
interactive games, separation anxiety
crawls, and pulls to stand
grasp with thumb
first words begin
milestones for 1 year
separation anxiety
walks with help, pincer grasp, makes twoer of 2 blocks
5-10 vocab
milestones for 18 months
parallel play walks forward and backward makes tower 4 blocks and uses cup or spoon 10-50 words 2 word sentence
milestones for 2 year old
dresses with help
runs, climbs stairs
tower 6 blocks
50-75 words and 3 word sentences
milestones 3 year old
magical thinking gender identity climbs and descends stairs makes tower 9 blcoks draws circle
milestones for 6 year old
skips, draws a person
fluent speech
milestones for 6 year old
skips, draws a person
fluent speech
what weight is considered failure to thrive
less then 5th percentile
hoes does height increase in first year of life
50%
doubles 4 years
triples 13
greater than normal height assoc with what
familial, precocious puberty, gigantism, hyperthyroidism, klinefelter, marfan or obesity
lesser than normal height assoc with what
familial neglect turners constitutional growth delay chronic renal failure asthma CF IBD immunologic disease growth hormone deficiency hypothyroidism glucocorticoid excess kskeleteal dysplasias neoplasm
when do you meausre head circumgerence
first -3 years
growth that declines after birth
post natal onset
growth that is anormal from time of birth
prenatal
growth that is consistently low
genetic
doctor visits in 1st month
one at 2 weeks
one at 1 month
doctor visit schedule 2 mo to 2 years
2,4 and 6 months
then 9,12,15,18
then after age 2 annual visits
when is the H flu b vaccine not necessary
children >5 that were never vaccinated because low risk of infection at this age
which children should always always receive Hflu-b and pneumococcal vaccines
asplenic
when do children socially smile
2 months
when do children coo
2 months
when do children laugh
4 months
when do children have stranger anxiety
6 months
motor skills at 6 months
roll over and holds up with hands
sits without support
when do children babble
6 months
milestones of 9 month olf
interactive games, separation anxiety
crawls, and pulls to stand
grasp with thumb
first words begin
milestones for 1 year
separation anxiety
walks with help, pincer grasp, makes twoer of 2 blocks
5-10 vocab
milestones for 18 months
parallel play walks forward and backward makes tower 4 blocks and uses cup or spoon 10-50 words 2 word sentence
milestones for 2 year old
dresses with help
runs, climbs stairs
tower 6 blocks
50-75 words and 3 word sentences
milestones 3 year old
magical thinking gender identity climbs and descends stairs makes tower 9 blcoks draws circle
milestones 4 year old
plays with others
hops on 1 foot
draws a cross and triangle
4 word sentences
milestones for 6 year old
skips, draws a person
fluent speech
moro reflex
extension head causes extension and flexion of limbs
startle reflex
up until 3 months old
grasp reflex
placing finger in palm causes grasping
up until 3 months old
rooting
rubbing cheek turns mouth
up until 3months old
placing reflex
rubbing foot dorsum causes foot to step up
up until 2months
screening in newborn/1 week old
PKU hypothyroid maple syrup urine disease CF hearinb, visual mobility and red reflex
when do teens have increased confidence and more open relationship with parents
17-21
when do you introduce solid foods like pureed and vegetables
4-6 months
when do kids start teething
4 months
when do check for anemia in kids
9 months
when to check lead exposure and PPD in kids if in high risk area
1 year
when do kids transition from crib to bed
around 2 years old
screening in 3 year old
visual acuity, cholesterol
routine dental checkups
when to start checking hearing in children
4 years old
Hep B series
birth
1-2 mo
6-18 mo
Rota virus series
2,4,6
DTaP series
2,4,6,15-18
4-6yr
Tdap at 11-12 yr
Hib series
2,4,6 and 12-15
PCV series pneumococcal
2,4,6,12-15
IPV series
2,4,6-18 4-6yr
MMR series
12-15
4-6 yr
VZV series
12-15
4-6 yr
Hep A series
1st at 12 mo
2 given at least 6 mo apart
MCV meningococcal series
11-12 yr and 16-18 yrs
HPV series
can start around 11/12
do 3 doses over 6 month period
Tanner 1 in men
small genitals
Presentation Wiskott Aldrich
susceptible to encapsulated bacteria and opportunistic infections
eczema and thrombotyopenia
easy bleeding, decreased IgM
WASP gene
Tanner 3 in men
penile enlargement and further testicular growth
more hair growth
Tanner 4 men
penile glans enlargement and darkening scrotal skin
hair becomes coarser
Tanner 5 men
adult
adolescence
10-19 years
when do teens desire independence and start having sexuality
14-16 years
when can doctor break confidentiality with teen patient
life threatening concerns like suicidal ideation, homicidal ideation, life threatening disease
main cause of death for teens
accidents
why do immune disorders not present early after birth
still have maternal Ab for around 3 months
What are the congenital T cell disorders
DiGeorge and Chronic mucocutaneous candidiasis
DiGeorge characteristics
tetany facial abnormalities decreased Ca congenital heart disease no thymid shadow 22q11
Tx DiGeorge
Ca Vit D thymic transplant bone marrow transplant surgery for heart IVIG or prophylactic antibiotics
Dx chronic mucocutaneous candidiasis
poor reaction to C albicans anergy test
decreased IgG
What are the congenital B cell disorders
X linked agammaglobulinemia
IgA deficiency
Hyper IgM disease
Common variable Immunodeficiency
presentation X linked agammaglobulinemia
low B cell and Ab levels X linked so more common in boys recurrent bacterial infections after 6 months old no B cells in peripheral smear total Ig levels are low
presentation IgA deficiency
increased respiratory and GI infections
normal level other Ig
Presentation IgM disease
defect in CD40 L on T cell causing bad interaction with M cells
low IgG and high IgM
possible anemia and thrombocytopenia and lymphopenia
infections in IgM disease
encapsulated bacteria (pulmonary and GI)
risk of trisomy increases significantly after what age of woman
35
presentation common variable immunodeficiency
low Ig lvels
increased resp and GI illnesses in second decade of life
increased risk neoplasm and autoimmune disorders
poor response to vaccines
common variable immunodeficiency
T cells in common variable immunodeficiency
decreased CD4:CD8 T cell ratio
Combined T and B cell congenital disorders
SCID
Wiskott Aldrich
Ataxia-Telangiectasia
Presentation SCID
abset T cells
significant recurrent infections
fatal at any age
decreased WBCs and Ig
Tx for SCID
IVIG
antibiotics
BM transplant
no live or attenuated vaccines
Presentation Wiskott Aldrich
susceptible to encapsulated bacteria and opportunistic infections
eczema and thrombotyopenia
Tx for wiskott aldrich
splenectomy
antibiotics
IVIG
BM transplant
Presentation ataxia-telangiectasia
auto recessive
cerebellar dysfunction, cutaneous telangiectasias after 3 years old
increased risk CA
impaired WBC and IgA development
Congenital phagocytic disorders
chronic granulomatous disease
Hyper IgE disease
Chediak Higashi syndrome
Leukocyte adhesion deficiency
Presentation and problem in chronic granulmoatous disease
Neutrophils cannot digest bacteria
recurrent bacterial and fungal infections
cutaneous, pulmonary and perirectal abscess
chronic lymphadenopathy
Tx chronic granulomatous disease
prophylactic antibitoics
gamma IFN
corticosteroids
BM transplant
Hyper IgE syndrome “Jobs”
defect in netrophil chemotaxis
T cell signaling and overproduction IgE
chronic dermatitis, recurrent skin abscesses and pulmonary infections
!! retained first teeth and coarse faicalfeatures
increase esosinophils
Tx hyper IgE syndrome
prophylactic antibiotics, skin hydration and emollient use
Chediak Higashi syndrome
auto recessive dysfunction neutrophils recurrent staph, strep and gram - and fungal infections abnormal platelets. Albinism!!!! neurologic dysfunction
Dx Chediak Higashi
large granules in granulocytes on peripheral smear
Tx chediak higashi syndrome
prophylactic antibiotics
BM transplant
Leukocyte Adhesion deficiency
inability neutrophils to leave circulation from integrin malfunciton (type 1) or E selectin malfucntuin (type2) recurrent infections URI and skin delayed separation umbilical cord short stature abnomral facies cognitive impairment
diagnosis leukocyte adhesion deficiency
increased serum neutrophils
defective chemotactic response upon stiulation
Tx leukocyte adhesion deficiency
prophylactic antibiotics
BM transplant
type 2 Tx with fructose
complement deficiencies are predisposed to what
SLE
Turners
45XO
usually end in abortion
female has short stature, infertility, abnormal genital formation, coarctation, craniofacial abnormalities (neck webbing)
47 XXY
klinefelter male with testicular atrophy tall and thind body gynecomastia infertility mild mental retardation
when do most trisomies occur
nondisjunction during meiosis of maternal germ cells
characteristics of down
mental retardation craniofacial abnormalities vision and hearing loss simian crease on hanfs cervical spine instability increased space in 1st and 2nd toes increased risk duodenal atresia alzheimers disease ALL cardiac defects
Characteristics edwards
trisomy 18
mental retardation, small mouth, rocker bottom feet overlapping fingers cardiacdefects GI abnormalities fatal in first year usually
characteristics trisomy 13
cleft lip and palate cardiac defects CNS defects severe mental retardation polydactyly fatal in first year usually
What is used to Dx deletion syndromes
FISH and karyotyping
Fragile X syndrome genetics
X linked mental retardation
males > females
high terminal cGG codon repeats
characteristics fragile X
large face with prominent jaw and large ears mild hand and foot abnormlaites large testicles mental retardation hyperactiivty with possible seizures
Most common cause familial mental retardation in men
fragile X syndrome
cri du chat
entire 5p deletion high pitched cat like cry small head small birth weight early mortality from failure to thrive
wolf hirschhorn
4p16 deletion
metnal retardation and cranial abnormalities
prader willi
15q11 and 15q13 deletion paternal allele
overeating obesity and decreased muscular tone in infancy
angelman
15q11-q13 deltion on maternal allele
get puppet like movement
happy mood and unprovoked laugher
mental retardation and seizures
velocardiofacial
22q11 deletion
cleft palate, cardiac, speech disorders, significant overbite
T cell deficiency
Di George like Sx
Williams deletion in kids
7q11.23 look like an elft with short upturned nose and long philtrum wide mouth mental retardation cheerful personality cardiac defects
