Pedo (Husson) Flashcards
2
Q
The American Academy of Pediatric Dentists recommend first dental visit by what age?
A
One year old
3
Q
What is the term for the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivery in a comprehensive, continuously accessible, coordinated and family-centered way?
A
Dental Home
4
Q
For first 3 years of life, who will see the patient more, the Medical Home or the Dental Home?
A
The medical home for the first 30 months and then after that, the dental home
5
Q
What is the Pediatric communication Triangle?
A
Dentist to child to parent with society in the middle
6
Q
Is the Pediatric Communication Triangle equilateral, isosceles, 30-60-90, or 45-45-90?
A
Equilateral
7
Q
What information should be annotated with taking the medical history of the child?
A
Date, time, who is giving the history (guardian, non-guardian, child)
8
Q
What is the SOAP note portion describing symptoms the patient verbally expresses or are described/stated by a parent, including the patient’s descriptions of pain or discomfort?
A
Subjective
9
Q
The patient’s own words are called what, should be annotated how, and go where?
A
Chief complaintIn quotes Subjective portion
10
Q
What are the 7 attributes of the History of Present Illness (description of the patient’s CC)?
A
- Location
- Quality (sharp vs dull)
- Quanity/Severity (pain scale)
- Timing (onset/duration/frequency)
- Where happened
- Aggravated/ relieved with
- Associated symptoms
11
Q
What else is reviewed in the subjective portion?
A
Review of medical history Allergies, Medications, Immunizations up-to-date
12
Q
What is the acronymn for social history in subjective data?
A
T - tobacco use or use in the home A - alcohol use or use in the home D - drug use or use in the home D - diet E - education level L - living and transportation arrangements
13
Q
The review of systems (general, skin, HEENT/T/N, cardiopulmonary, GI & GU, Vascular, Hematologic, Endocrine, Neuromuscular, Psychiatric) goes in what part of the SOAP note?
A
Subjective
14
Q
What is the SOAP area that records symptoms that can actually be measured, seen, heard, touch, felt or smelled [signs] (e.g. height, weight, vitals, skin color, swelling, results of diagnostic tests)?
A
Objective
15
Q
What is considered a “normal” BMI?
A
18.5-24.9 BMI = wt(kg)/ht2(m)
16
Q
What is the age at which a child should be compared on the WHO growth standards chart for an objective physical exam?
A
0-2 yrs
17
Q
In how many places should you ausculate the lungs?
A
Bilaterally front and back in 4-6 spots each
18
Q
In how many places should you ausculate the heart?
A
Four
19
Q
In what SOAP area do you write the diagnosis of a patient’s condition or differential diagnosis?
A
Assessment
20
Q
What is the SOAP area that is treatment planned today and future treatment?
A
Plan
21
Q
What is the most dramatic difference in the pediatric patient versus the adult patient?
A
Physical size
22
Q
What is the most predominant part of the head of a newborn?
A
Occipit
23
Q
Why are newborns more heart rate dependent?
A
Their sympathetic NS is not fully functioning yet, therefore they cannot aide BP with good vasoconstriction or vasodilation as needed
24
Q
Which autonomic nervous system is fully functional at birth?
A
Parasympathetic
25
Q
A child’s respiratory system usually matured by what age?
A
8 yrs
26
What is the age of a baby that can sit unassisted?
9 months
27
What is the age of a child with a 1-2 word vocabulary, plays peek-a-boo, recognizes common words?
7 to 12 months
28
What is the age of a child that can follow 2 requests, understands differences in meanings, has 2-3 word sentences, familiar listeners can understand speech?
2-3 years
29
What is the age of child that understands who,what, when, where questions, has 4+ word sentences, speech understood by non-family members?
3 to 4 years
30
What is the age of a child that pays attention to a short story, answers simple questions, and can say most sounds?
4 to 5 years
31
Who has a higher respiratory rate: children or adults?
Children
32
Why do children have a higher respiratory rate than adults?
Children have less lung capacity
33
What is an infant's respiratory rate?
30-60 bpm
34
What is the respiratory rate of a 6-12 year old child?
18-30 bpm
35
What is the respiratory rate of an adolescent (13 to 18 years old)?
12-16 bpm
36
A respiratory rate of ______ in a child of any age is abnormal and imminent sign of respiratory failure?
More than 60 bpm
37
What is the term for a respiratory rate that is faster than normal for the patient's age?
Tachypnea
38
What is the first sign of respiratory distress in infants?
Tachypnea
39
When is tachypnea normal?
As a response to stress/fear
40
What is the term for a respiratory rate slower than normal for a patient's age?
Bradypnea
41
What are some causes of bradypnea?
1. Fatigue
2. CNS injury
3. Infection
4. Hypothermia
5. Medications
42
What is the narrowest part of the airway for children?
Cricoid
| In adults it is the vocal chords
43
What is the term for the cessation of inspiratory airflow for 20 seconds or for a shorter period of time, likely accompanied by bradycardia or cyanosis?
Apnea
44
What is a concern due to pediatric funnel-shaped trachea?
Easily get edema and swelling in airway
45
What are anatomic concerns with the pediatric airway?
Large head with prominent occiput, short neck, small nostrils, large tonsils and adenoids, big tongue, small mouth
46
What is the character of the muscle fibers in a child of less than 8 months that causes them to tire easily?
Have less Type I high oxidative muscle fibers
47
With the pliability of their ribs, the stiffer diaphragm, smaller alveoli, all contributing to decreased total lung capacity (TLC), what is increased in children and what is the status of their oxygen reserve?
Increased respiratory rate and less oxygen reserve
48
What sinuses are present during infant life?
Maxillary and ethmoids
49
What is caused by simultaneous inflammation obstructing ostia leading to mucous retention and bacterial infection and the result can mimic a toothache?
Sinusitis
50
What is a differential for a toothache versus sinusitis?
True toothache is unilateral while sinusitis is unilateral or bilateral
51
What are the day ranges for acute, subacute and chronic sinusitis?
Acute 90 days
52
What is the term for nasal drainage due to infection, allergy or mechanical obstruction and can lead to sore-throat, inflamed tissues and pressure headaches?
Rhinorrhea
53
What are the 3 most common bacterial organisms in acute sinusitis?
1. Strep pneumonia
2. Haemophilus influenza
3. Morexella catarrhals
54
What has the following symptoms: cough, halitosis, purulent nasal discharge, headache, unilateral facial pain?
Sinusitis
55
Epistaxis/Nose bleeds are due to what group of vessels?
Kiesselbach's plexus in anterior nasal septum
56
When is epistaxis common?
Winter months due to dry air
57
How long should you compress for with epistaxis?
5 minutes
58
What is the most important prevention of epistaxis?
Proper humidification of air
59
What is the term for the lymphoid tissue on the superior and posterior walls of the nasopharynx whose hypertrophy can result from infection and can cause nasal obstruction, a long face, open bite, and drying of anterior nasal mucosa (mouth breather)?
Adenoids
60
What is the tonsil classification system, based on the amount the palatine tonsils occlude the airway, zero being no occlusion, 4 being more than 75% occluded (scale increases by increments of 25%)?
Brodsky
61
Are decongestants or antihistamines indicated for adenoid hypertrophy?
Only in allergy cases
62
What is the concern with velopharyngeal insufficency if adenoids are removed?
Can cause hypernasal speech as with cleft palate
63
What is most commonly caused by hypertrophied adenoids and tonsils?
Obstructive sleep apnea (OSA)
64
What can be viral (coxsackie, EBV, CMV, HIV) or Bacterial (S pyogenes, C diptheria) causing tonsilar exudates, fever, strawberry tongue, scarlantiniform skin?
Pharyngitis
65
What reaches its peak in early childhood and is rare after 8 years old (the infection is in the middle ear by bacteria from the nasopharynx)?
Acute otitis media
66
Frank pus from the ear indicates what?
Perforated eardrum
67
What is the risk associated with untreated acute otitis media?
Mastoiditis, intracranial abscess leading to death or permanent hearing loss
68
What is the main prescription for children with bacterial infection?
Amoxicillin 40mg/kg total dose, spread out 3 times a day
69
What is a congenital obstruction of the posterior nares, 90% by a bony palate, 75% are unilateral, and occur more frequently in females (commonly associated with other congenital abnormalities(cleft palate). Bilateral will cause severe respiratory distress that disappears when baby cries)?
Choanal atresia
70
What is a lung infection that can be caused by either virus or bacteria, occurs quickly in children?
Pneumonia
71
Will bacterial pneumonia will have an abrupt or a gradual onset versus viral pneumonia?
Bacterial abrupt onset
72
Pneumonia is a risk when the child has a history or what?
Upper airway infection
73
What are 3 ways to diagnose pneumonia?
1. Chest x-ray
2. White blood cell count
3. Physical auscultation giving dull sound over lung, wheezing, rales, or decreased breath sound
74
What is an acute inflammation of the supraglottic structures and indicates a true medical emergency?
Epiglottitis
75
Epiglottitis is most common in what age group and is caused by what bacteria?
3-7 years old
| S pneumonia or Staph
76
If a patient has this, they will sit in a Tripod position to assist their breathing and a lateral neck film will show a "thumb sign".
Epiglottits
77
What is the most important step in treating epiglottits?
Securing the airway
78
What is done to the family of a child that has epiglottits?
Prophylaxis with rifampin
79
What is a chronic inflammatory disorder of the airway (2nd most common chronic childhood disease)?
Asthma
80
What are causes of asthma?
1. Multifactorial
2. Bronchoconstriction
3. Mucosal edema
4. Increased secretions with mucous plugging
5. Inflammatory mediator IgE
81
Is airflow obstruction in asthma partially or completely reversible?
Partially
82
What are 4 clinical features of asthma?
1. Wheezing
2. Nasal flaring
3. tachypnea
4. Cough
83
How would you classify asthma that is less than 2 day episodes/week and less than 1 night episode a month, with no activity limitation?
Well-controlled/ mild asthma
84
How would you classify asthma that is more than 2 day episode a week and more than 1 night episode a month with some activity limitation?
Not well-controlled / moderate
85
How would you classify asthma that is daily episodes, more than 1 night episode a week and limited activity?
Poorly controlled / Severe
86
How do you treat an acute asthma attack?
Inhale Beta 2 adrenergic agonists (bronchial smooth muscle dilator) Albuterol
87
What is an autosomal recessive disorder characterized by lung obstructive disease with progressive loss of pulmonary function (affects exocrine glands, patient presents with failure to thrive with life expectancy of 35 yrs)?
Cystic fibrosis
88
How is cystic fibrosis diagnosed?
Sweat chloride concentration being more than 60 mmol/L
89
Use of this is limited in both severe asthma patients and cystic fibrosis patients?
Nitrous oxide
90
What is the driving force to move blood throughout the body to deliver oxygen and nutrients?
Blood pressure
91
What is the formula for blood pressure?
```
BP = cardiac output x total peripheral resistance CO = Heart rate x stroke volume
BP = (HR x SV) x TPF
```
92
What is the character of a child's heart and its effect on heart rate?
Child's heart muscle is stiffer and cannot increase CO, so must beat faster to keep circulation
93
At what age does a child have an awake HR of 85-205 with a mean of 140?
Newborn to 3 months
94
At what age does a child have an awake HR of 100-190 with a mean of 130?
3 months to 2 years
95
At what age does a child have an awake HR of 60-140 and a mean of 80?
2 yrs to 10 yrs
96
At what age does a child have an awake HR of 60-100 with a mean of 75?
More than 10 years
97
Bradycardia is usually caused by what in children?
Hypoxia
98
Why is bradycardia bad in kids?
They are heart rate dependent b/c their sympathetic NS is not developed enough to modulate TPR to offset decreased CO
99
What is the bradycardia danger zone rate for newborns to 10 yrs old?
Less than 60 bpm
100
What is to be considered if a small child with HR less than 60 bpm?
Start chest compressions
101
What 2 areas shunt the blood away from fetal lungs and the liver during development?
```
Foramen ovale (heart)
Ductus arteriosus
Ductus venosus (liver)
```
102
S1 heart sound is caused by what?
Mitral and tricuspid valves closing at ventricular contraction (systole)
103
S2 heart sound is caused by what?
Pulmonary and aortic valves closing at ventricular relaxation (diastole)
104
What are 4 auscultation areas for the heart?
1. Top right (aortic)
2. Top left (Pulmonic)
3. Left lateral sterna border (Tricuspid)
4. Apex (mitral)
105
What is the noise blood makes as it flows through the heart caused by disruption of normal laminar flow (80% of children have one at some point. Is not a disease, but may indicate a problem. Gives a whooshing or swishing sound)?
Heart murmur
106
What is an innocent buzzing sound with exercise on the left side?
Stills murmur
107
What is an innocent blowing sound with exercise?
Pulmonic systolic murmur
108
What is an innocent continuous hum with sitting/inactivity?
Venous hum
109
What are some causes of innocent heart murmurs?
1. Exercise
2. Pregnancy
3. Fever
4. Heart Surgery
5. Anemia (not enough oxygen)
6. Hyperthyroidism
110
What does "organic heart murmur" mean?
Murmur caused by a pathologic abnormality
111
What are 3 examples of organic heart murmurs?
1. Congenital heart defect
2. Damaged valve
3. Infection (rheumatic fever)
112
How are murmurs described?
When they occur in cardiac cycle (systolic, diastolic, continuous)
113
What grade of murmur is very faint?
Grade 1
114
What grade of murmur is faint but unmistakably heard?
Grade 2
115
What grade of murmur that is louder than faint, but has no thrill?
Grade 3
116
What grade of murmur is loud and has a thrill?
Grade 4
117
What grade of murmur is very loud but still needs a stethoscope on the chest?
Grade 5
118
What grade of murmur is able to be heard with a stethoscope off the chest?
Grade 6
119
What must be determined when classifying a congenital heart disease?
Whether there a shunt or an obstruction
120
What are 2 general classes of congenital heart disease?
1. Acyanotic
| 2. Cyanotic
121
What are three types acyanotic, shunting congenital heart disease?
1. Ventricular septal defect (VSD)
2. Atrial septal defect (ASD)
3. Patent Ductus Arteriosus (PDA)
122
What is the most common congenital heart defect?
Ventricular septal defect?
123
What are 3 types of acyanotic heart defects with obstruction heart diseases?
1. Aortic stenosis
2. Coarctation of the aorta
3. Pulmonary stenosis
124
In general, what is more frequent: an acyanotic heart defect with shunting or an acyanotic heart defect with obstruction?
Acyanotic with shunting
125
What is an acyanotic disease with right atrial and ventricular enlargement commonly found in patients with Downs Syndrome?
Atrial Septal Defect (acyanotic, shunting)
126
What is an acyanotic disease having connection of the aorta to the pulmonary artery and has bounding pulses?
Patent ductus arteriosus (acyanotic, shunting)
127
What is an acyanotic disease with chest pain, syncope and exercise intolerance in older kids?
Aortic stenosis (acyanotic, obstruction)
128
What are 5 types of cyanotic congenital heart diseases, in order from most to least common?
1. Tetralogy of Fallot
2. Transposition of Great Arteries
3. Tricuspid Atresia
4. Truncus Arteriosus
5. Total Anomalous Pulmonary Venous Connection
129
Tetralogy of Fallot is what 4 classic defects together?
1. Large Ventral Septal Defect
2. Pulmonary Artery stenosis
3. Right ventricular hypertrophy
4. Overriding aorta (sits over more than just left ventricle)
130
What is the term for the look of Tetralogy of Fallot?
Blue babies
131
What is a physical sign of tetralogy of Fallot beyond cyanotic appearance?
Clubbing of fingers
132
In the cyanotic congenital heart disease "Transposition of the Great Vessels", what is required for survival?
Another defect: patent ductus arteriosus
133
What is the term for when the heart lacks the right atrioventricular connection so that the right ventricle is hypoplastic and the tricuspid valve is absent and there is poor pulmonary circulation?
Tricuspid atresia
134
What is the blood flow in a tricuspid atresia patient dependent on?
Patent ductus arteriosus (like in transposition of great vessels)
135
What cyanotic congenital defect has the pulmonary artery and the aorta come from the same trunk and will have a ventral septal defect superimposed?
Truncus arteriosus
136
What is a cyanotic congenital defect where the pulmonary artery and the aorta come from the same trunk and will have a ventral septal defect superimposed?
Truncus arteriosus
137
What is a cyanotic congenital defect where pulmonary veins drain into the right atrium, and the superior and inferior vena cava (will also have an atrial septal defect or a patent foramen ovale)?
Total anomalous pulmonary venous connection
138
What does SBE prophylaxis mean?
Subacute bacterial endocarditis prophylaxis
139
The guidelines for SBE-prophylaxis state what type of unrepaired congenital heart defect requires SBE-prophylaxis
Unrepaired Cyanotic CHD
140
Infection of the heart's inner lining, occuring near congenital defects is called what?
Bacterial endocarditis
141
What are the offending bacteria of bacterial endocarditis?
Viridans streptococi
142
Does Type II progress towards ketoacidosis? Why or why not?
Only in very rare circumstances because Type II diabetics produce a basal level of insulin.
143
Why does a patient with ketoacidosis have rapid breathing?
Tachypnea is an attempt to reverse the acidosis by breathing a lot (I guess)
144
Does Type I progress towards ketoacidosis? Why or why not?
Type I Diabetics commonly progress towards DK because they do not produce any insulin.
