Peds Flashcards
What is failure to thive
Weight that falls below the 3rd to 5th percentile for gestation corrected age and gender when plotted on an appropriate growth chart
Or a weight change that shows a decrease over 2 or more major percentile lines
What are the causes of FTT
- inadequate dietary intake
- Diarrhea
- Malabsorption (celiac, CF, food allergies)
- poor maternal bonding
- frequent infections
What is Down Syndrome
A genetic defect caused by trisomy of chromosome 21
What are features of Down Syndrome
- Round, flat face (decreased anterior-posterior diameter)
- Upward slanting eyes (palpable fissures)
- Low set ears
- Macroglossia
- short neck
- short fingers, small palms, broad hand with transverse palmar creases
- newborns with: hypotonia and poor moro reflexes
Down syndrome increases the risk of
- intellectual disability
- congenital heart defects
- feeding difficulties
- congenital hearing loss
- thyroid disease
- cataracts
- sleep apnea
- early onset alzheimers
What are the classic features of fetal alcohol syndrome
- small head (microcephaly)
- Epicanthal folds
- flat nasal bridge
- thin upper lip
- no vertical groove above the upper lip (smooth philtrum)
- underdeveloped ears
- neurocognitive/behavioral problems
When do symptoms of gonococcal ophthalmia neonatorum
2-5 days after birth
What is the concern with gonococcal ophthalmia neonatorum
blindness
What are sx of gonococcal ophthalmia neonatorum
- injected conjunctiva with profuse purulent discharge
- swollen eyelids
Any neonate with acute conjunctivitis within 30 days or less of birth should be tested for:
- Chlamydia
- Gonorrhea
- HSV
- Bacterial infection
What tests should you order for a neonate with suspected gonococcal ophthalmia neonatorum
- Gram Stain
- Gonococcal culture or PCR
How do you treat gonococcal ophthalmia neonatorum
- Hospitalize
- High dose IV/IM Cefotaxime
When do symptoms of chlamydial ophthalmia neonatorum present
4-10 days after birth
What are sx of chlamydial ophthalmia neonatorum
- edematous eyelids
- redness
- watery discharge that may become purulent
How is chlamydial ophthalmia neonatorum treated?
-Erythromycin QID x 14 days
What is Sudden Infant Death Syndrome
Death in apparently healthy infants <12 months, which cannot be explained after a thorough case investigation including scene survey, autopsy and review of clinical history
What are risk factors for SIDS
- Prematurity
- Low birth weight
- Maternal smoking/drug use
- Poverty
How can you decrease the risk of SIDS
- back to sleep
- firm sleep surface
- encourage breastfeeding
- Immunizations
- Room share without bed share
- pacifier for bedtime
- avoid soft objects and loose bedding in the sleep area, smoke exposure and overheating infant
When should neonatal weight loss be regained after birth
10-14 days
What are signs of severe dehydration in infants
- weak and rapid pulse
- tachypnea
- deep breathing
- parched mucous membranes
- markedly sunken anterior fontanelle
- tenting skin turgor
- cool skin
- acrocyanosis
- anuria
- changes in LOC
A blue to black colored patch or stain most commonly on the lumbosacral area in newborns of native American, hispanic and black ethnicity
Mongolian spot or Congenital dermal melanocytosis
Multiple white 1-2 mm papules located on the forehead, cheeks and nose of neonates
-Milia or Miliaria
What is seborrheic dermatitis
-excessive thick scaling on the scalp of young infants
Hows is seborrheic dermatitis treated
- soaking scalp with vegetable or mineral oil
- mild baby shampoo
- removing scales with soft brush or comb
What is a faun tail nevus and what can it be a sign of?
- Tufts of fair overlying the spinal column usually at the lumbosacral area
- Can be a sign of neural tube defects
What test should you order in a baby with a faun tail nevus
Ultrasound to rule out occult spina bifida
Flat light brown to dark brown spots >5mm
Cafe-au-lat spots
If you have >6 cafe-au-lait spots larger than 5mm what do you need to rule out
Neurofibromatosis or von Recklinghausen’s
Flat pink patches found on the forehead, eyelids, nape of neck. Blanchable. Color changes with crying, breath holding and room temperature. Usually on both sides of midline in newborns are called
Nevus simplex or stork bites
Neonates with pink to red, flat, stain like skin lesion. Blanches to pressure, irregular in shape and size. Unilateral are
Port wine stain
What do you need to rule out in a baby with a port wine stain?
- Trigeminal nerve involvement
- Sturge-Weber syndrome
Raised vascular lesion ranging in size form 0.5-0.4cm, bright red in color, soft to touch.
Hemangioma
When do hemagiomas resolve?
-most involute gradually over 1-5 years
At 1 month visual screening includes that an infant ca
Briefy fixate on mom’s face
At 3 months visual screening includes that an infant will
Hold their hands close to their face and observe them, will fixate on a toy or object
At 6 months visual screening includes that an infant will
Make good eye contact
Turn head to scan 180 degree visual field
At 12 months visual screening includes that an infant will
Make prolonged eye contact when spoken to
-recognizes self in mirror and favorite people from a distance
What is stabismus
Misalignment of the eye
What is esotropia
Inward turning of the eye
What is exotropia
Outward turing of the eye
What are the risks of uncorrected strabismus
- permanent vision loss
- abnormal vision (diploia)
What are the treatment options for strabismus
- Eye glasses
- eye exercises
- prism
- eye surgery
Indications for referral to peds opthalmology
- abnormal red reflex
- presence of white reflex
- strabismus
- Greater than 2-line difference between each eye
- Esodeviation after 3-4 months
- Abnormal corneal light reflex
- Shape/appearance of pupils not equal
- New onset of strabismus
What can a white color on the check for a red reflex signify
- cataracts
- retinoblastoma
- leukocoria
What does the corneal light reflex or Hirschberg test screen for
Strabismus
HEARS for hearing loss
- Hyperbilirubinemia
- Ear infections (frequent)
- Apgar scores (low)
- Rubella, Cytomegalovirus, toxoplasmosis
- Seizures
*Also preterm infants are at greater risk
PKU is
A disorder that causes an inability to metabolize phenylalanine to tyrosine because of a defect in the production of the enzyme for phenylalanine hydroxylase
-must be done only after 48 of feeds
Healthy infants have enough iron stores to last up to ___ months
6 months
Vitamin D drops should be given to breastfed babies at ____ dose
400 IU
Avoid cows milk in the 1st ____ of life because of the risk of _____
12 months; GI bleeds
Wait until ____ months to introduce solid foods and start with ____
4-6 months; iron fortified cereals
Introduce 1 food at a time for ___ to ___ days
4-5 days
Failure to pass meconium within ____ hours is concerning`
24
Head circumference will increase by ____cm in the first 12 months of life
12
What is a difference between caput succedaneum and cephalohematoma
-a cephalohematoma does not cross the suture line
Infants between 0-6 months growth includes a weight gain of ____/week and height of _____/month
- 6-8oz/week
- 1 inch/month
Infants between 6-12 months growth includes a weight gain of ____/week and height of _____/month
- 3-4oz/week
- 1/2 inch/month
Symptoms of teething
- fever
- drooling
- chewing on objects
- irritability
- crying
First teeth erupt between ___ to ___ months and are the _____ teeth
6-10 months; lower central incisors
Kids have their full set of primary teeth by
2.5 years
First permanent teeth erupt by age
6
Epispadias is
when the urethral meatus is on the dorsal aspect of the penis
Hypospadias is
when the urethral meatus is on the ventral aspect of the penis
Birth weight ___ by 6 months and ___ by 12 months
Doubles by 6 months, triples by 12 months
Anal wink reflex
stroke anal region and look for perianal muscle contraction
-If absent: abnormal suggests spinal cord lesion
Plantar reflex or babinski
Upward extension of the big toe with fanning
Palmar reflex
Infant will close its hand around the finger
Moro reflex
Startle, sudden loud noise will cause symmetrical abduction and extension of the arms followed by adduction and flexion of the arms over the body
A strong moro in an older infant beyond ____ months of age is
6 months is abnormal and indicative of brain damage
When should the moro reflex disappear
3-4 months
Step reflex
Holding baby upright allow the dorsal surface of 1 foot to touch the edge of the table. baby will simulate a stepping motion
When does the step reflex disappear
6 weeks
Tonic neck reflex
Turning ehad to one side with jaw over shouler will cause the arm and leg on the same side to extend while opposite arm and leg flex
Rooting reflex
Stroking corner of mouth causes sucking
When does rooting reflex disappear
3-4 months
When does an infant first get an MMR-V vaccine
12 months; 2nd dose at 4-6 years
When does an infant first get an influenza shot
6 months
What are contraindications to the influenza vaccine
<6 mths old
- severe egg allergy
- moderate to severe illness with fever (wait until better)
- Hx of GBS
DT is used for
Infants and children <7
Tdap is used at what ages
for ages 7 and older
What are SE of DTaP or DT
- Fever
- swelling, pain, redness at site of injection
- irritability
- acute encephalopathy
By 15-18 month the following vaccines are usually complete for most infants
- Hep B (3 doses)
- Hib
- PCV 13 (4 doses)
- Rotavirus (2-3 doses)
- Hep A (2 doses)
Give Tdap at age ___
11-12
At 2 months old a baby can
- Follow objects past midline
- coo vowels
- lifts head when prone
- smiles in response to others
At 4 months old a baby can
- smile sponatenously
- babbles
- hands to mouth
- holds head steady
- rolls front to back (supine to prone)
At 6 months old a baby can
- has palmar graps
- brings things to mouth
- passes things from hand to hand
- begins to sit independently
- rolls in both direction
- Says consonants (da-da, ba-ba)
At 9 months old a baby can
- pincer grasp, can pick things up between thumb and forefinger
- waves bye
- claps hands
- pulls to stand
- crawls and cruises
- bears weight
- plays peak a boo
- stranger anxiety
At 12 months old a baby can
- use a sippy cup
- stand independenly
- start to cruise
- can say 1-2 words
- knows name
- follows simple commands
- growth rate slows
At 15 months old a toddler can
- feed self with spoon
- drink from a cup
- walk independently for longer distances
- follow commands
- vocab of 4-6 words
At 18 months old a toddler can
- turn pages of a book
- walk up step
- point to 4 body parts
- vocab of 10-20 words
Rear facing car seat is recommended up to the age of
2
What is hyperbilirubinemia
elevation of bilirubin due to increased breakdown of fetal RBCs exceeding the infant’s liver capacity to conjugate bilirubin
-can become toxic and deposit in tissue causing necrosis
Jaundice in the 1st ____ hours of life is always _____
24hrs is always pathologic
Pathologic jaundice should be evaluated for
- sepsis
- TORCH
- occult hemorrhages
- erythroblastosis fetalis
What is the treatment plan for neonatal jaundice
- check bilirubin level (TCB then TSB)
- If suspected pathological jaundice order: Coombs, CBC, Bilirubin, reticulocyte and peripheral smear
- Feed baby q2-3 hours
- Phototherapy is first line
What is a complication of hyperbilirubinemia
Bilirubin encephalopathy (kernicterus)
What is physiologic anemia of infancy
Hemoglobin drops to its lowest level 8-12 weeks of age
What are sx of congenital lacrimal duct obstruction
- persistant tearing
- eyelash matting
- no conjunctival erythema
- reflux of mucoid discharge when lacrimal duct palpated
Sx of Acute dacryocystitsis
- redness
- warmth
- tenderness
- swelling
Rule of 3’s for colic
- crying for no apparent reason that lasts >3 hours in -an infant <3 months
- crying occurs at the same time every day
- Crying occurs >3 days/week
*resolves by 3-4 months
Coarctation of the aorta
narrowing of a portion of the aorta
How to screen for coarctation of the aorta
-compare femoral and brachial pulse simultaneously (absence or delay is diagnostic)
- In older infants: BP in arms and legs
- Abn if BP higher in arms than legs
What is Barlows maneuver
Place your index finger and middle finger over greater trochanter, push knees together at midline downward and upward
- is a clunk
- tests for DD of the hip
What is ortolani
- hold each knee and place finger over the greater trochanter. rotate hips in the frog leg position
- is a click or clunk
An asymmetric gluteal or thigh fold suggests
DD of the hip
What is the presentation of neuroblastoma
- abdominal (retroperitoneal or hepatic) mass that is fixed, firm and irregular
- frequently crosses the midline
- wt loss
- fever
- subcutaneous nodules
- Horner’s syndrome
- Periorbital ecchymoses
- bone pain
- hypertension
What is the most common site of a neuroblastoma
-Adrenal medulla
What are the diagnostic tests for neuroblastoma
- urinary catecholamines
- ultrasound
What is the presentation of a nephroblastoma
- asymptomatic abdominal mass that extends from the flank toward the midline
- non tender and smooth mass
- rarely crosses the midline
- abdominal pain
- hematuria
- hypertension
What is the dx test for nephroblastoma
-ultrasound
What is the presentation of epiglottis
- acute onset of high fever, -chills
- muffled hot potato voice
- anxiety
- stridor
- tripoding
- tachycardia
- tachypnea
Where do osteomyelitis typically occur
at the metaphyses
What is the presentation of septic arthritis
- abrupt onset of unilateral hip or knee pain
- swelling
- warmth
What is the presentation of orbital cellulitis
- abrupt onset of deep eye pain that is aggravated bye eye movements
- high fever
- chills
- bulging eye
- abnormal extraocular eye movements
Orbital cellulitis is more likely to be caused by _____ sinusitis as opposed to ____ or _____ sinusitis
ethmoid
-frontal or maxillary
What is preseptal cellulitis
an infection of the anterior portion of the eyelid that dose not involve the orbit/globe of the eye
What are red flags for non-accidental trauma or child abuse
- posteriomedial rib fracture
- metaphyseal avulsion fracture
- bruises or fractures in various stages of healing
- delay in seeking medical care
- injuries inconsistent with the story
What are the top 3 causes of death in ages 1-4
- drowning
- congenital anomalies
- MVA
What are the top 3 cancers
- leukemia
- brain and nervous system tumors
- lymphomas
By 9 months if infantile reflexes remain strong this is considered
abnormal
At 1 a child can
- support own weight
- walk with hands help
- starts to cruise
At 2 years old a child can
- walk and run
- climb stairs holding onto handrails with 1 foot at a time
- speech is understood by family members
- can follow 2-3 step instructions
- Can copy a straight line
At 3 years old a child can
- speak 3 to 5 word sentences
- can be understood by strangers
- copies a circle
- rides a tricycle
- build a tower of more than 6 blocks
- runs and climbs easily
- throws ball
- stairs with alternating feet
At 4 years old a child can
- copy a cross
- draw a person with 3 body parts
- plays mom and dad
- hops and stands on 1 foot
- names colors and numbers
At 5 years old a child can
- draw a person with 6 body parts
- counts 10 or more
- aware of gender
- copy a square
- ride a bike
- dress and undress self
Red flags for autistic behavior are
- loss of skills at any age
- no pointing, reaching or babbling by 1 year
- no words by 16 months
- non 2 word phrases by 2 years
What are clues that a child is ready for toilet training?
- walking
- can reach potty chair
- knows the difference between wet and dry
- can communicate when having a bowel movement
- can pull down their own pants
- can stay dry for up to 2 hours at a time
- shows interest in toilet
Most children are ready for potty training at ____ to ___ months, but some children may not be ready until ____ months
18-24 months; 36 months
5 behaviors to look for with autism
- does not point/wave/grasp/reach
- no babbling by 12 months
- does not say a single word by 16 months
- does not say 2 word phrases on their own by 24 months
- loss of language or skills at any age
What are the sx of kawasaki disease
WARM CREAM
- Fever >5 days
- Conjunctivitis
- Rash: erythematous, maculopapular, morbiliform
- Erythema/Edema (palms and soles)
- Adenopathy, cervical
- Mucous membranes (strawberry tongue, dry & red)
What is the treatment of kawasaki disease
-IVIG and high-dose aspirin
What are sx of leukemia
- extreme fatigue
- weakness
- pallor
- easy bruising
- petechiae
- bleeding gums
- nose bleeds
- bone/joint bain
- lymphadenopathy
- abdominal swelling
The most common cancer in children is ____ and the most common type is ____
leukemia and ALL
What is ALL
- most common form of leukemia
- fast growing cancer of the lymphoblasts (immature lymphocytes
What is AML
-Fast growing cancer of the bone marrow that affects immature or precursor blood cells such as myeloblasts, monoblasts, erythroblasts and megakaryobalsts
What is reye’s syndrome
- History of febrile viral illness and aspirin or salicylate intake (ie. pepto) in children
- Abrupt onset with quick progression to death
Stage 1:
-severe vomiting, lethargic/sleepy, elevated ALT/AST
Stage 2:
-Deeply lethargic, restless, confused/delirious/combative/hyperactive reflexes, hyperventilation
Atlantoaxial instability is a risk in
Down syndrome
Absence seizures are
brief episodes when a child stops what they are doing
-may be described as daydreaming and inattentive
What is a still’s murmur
- benign systolic murmur that is described as having a vibratory or musical quality
- becomes louder when supine or with fever
- Grade I or II intensity
- minimal radiation
Top causes if death ages 5-9
- malignant neoplasm
- MVA
- Congenital abnormalities
Piaget stages of cognitive development
1) Sensorimotor- birth to 2
2) Preoperational- 2-7 year
3) Concrete operational- 7-11 year
4) Formal Operational- 12 year to adulthood
What is autism spectrum disorder
-neurodevlopmental disorder that affects the normal development of communication and social skills
What is a classic case of autism spectrum disorder
- child is extremely sensitive to noises, touches, smells or texture
- prefers to be alone
- poor eye contact
- does not interact well with others
- slow to poor language development
- repeated body movements
- regression
What medication may be helpful in autism spectrum
-risperidone
What is the presentation of fragile x syndrome
- macrocephaly and global developmental delays
- skills and behavior slow compared with peers
- hyperactive behavior
- learning disabilities
- long face
- prominant forehead, kaw and large protruding ears
What is the cause of hand foot and mouth disease
coxsackievirus A16
What are the sx of hand foot and mouth disease
- fever
- sore throat
- headache
- anorexia
- multiple small blisters on the hands feet and rectum and in the mouth
What is the treatment for hand foot and mouth disease
-symptomatic
Multiple small blisters appearing on the hands, feet, rectum and small ulcers in the mouth, throat, tonsils and tongue
hand foot and mouth
honey colored crusted lesions
impetigo
Koplik’s spots (small white papules) inside the cheeks (buccal mucosa) and erythematous maculopapular rash that begins on the face and spreads from head to feet but spares the palms and soles
Mealses or rubeola
Generalized rash in different stages: Papules –> vesicles –> pustules –> crusts. Pruritic. Very contagious
Varicella
Sandpaper rash with sore throat, strawberry tongue
-scarlet fever
Ovoid white nits on hair, red papules that are itchy and nits in the hairline
Pediculosis capitis (head lice)
Smooth waxlike round (dome shaped) apules ranging from a pin head to the size of pencil eraser (2-5mm). Central umbilication with a white plug
Mollouscum contagiosum
Maculopapular rash located in interdigital webs of hands, feet, waist, axillae, groin, very pruritic, can resemble pimples eczema and insect bite
Scabies
Presentation of functional constipation (encopresis)
- history of withholding of stool
- history of painful or hard bowel movements
- history of large-diameter stools that may obstruct toilet
- presence of large fecal mass in rectum
- 2 or fewer BM per week
- at least 1 episode of fecal incontinence per week
What is a diagnostic test to assist with functional constipation
X-ray
All 11-12-year-olds should be vaccinated with a single dose of
- Quadrivalent meningococcal vaccine (MenACWY) or Menactra and menveo
- Tdap
- HPV (if not already given)
HPV can be given as young as ____ and as old as _____
9 and 26
Child at the age of 11 years is in the _____ thinking of piagets theory
Early abstract
Fetal nutrition is best assessed by:
- hydration status
- weight
- subcutaneous fat on the anterior thighs and gluteal region
Anterior fontanelle should close between ____ and ____ months
9 & 18 months
Is Posterior fontanelle always open at birth
No
If the posterior fontanelle is open at birth when should it close by?
2 months
Hyperteiorism means
eyes are far apart
Low set ears may indicated renal
agenesis
A webbed neck may be associated with
turners syndrome (redundant skin along the posterolateral line)
Consider iron supplementation at ___ months
6 months
Eye evaluation for:
- Newborn to 3 months:
- 3-6 months
- 6-12 months
- > 3 years
- Newborn to 3 months: Red reflex, inspection
- 3-6 months: Fix and follow, red reflex, inspection
- 6-12 months: Fix and follow with each eye, red reflex, inspection, corneal light reflex (hirsberg)
- > 3 years: *Start to think about visual acuity
At what age should eye alignment occur
-between 2-4 months of age
What is amblyopia
Loss of vision
The corneal light reflex and cover/uncover tests are used to assess:
Strabismus
*start at 6 months-3 years
Children should have 20/20 by
6 years
hearing evaluation by age:
- Newborn to 3 months
- 3 to 6 months
- 6-12 months
- 12-18 months
- 18-24 months
- Newborn: Startle (moro)
- 3 to 6 months: stops and listen to new sound, stops crying with hearing parent’s voice
- 6-12 months: responds to own name
- 12-18 months: Follows directions without cues
- 18-24 months: 50% of speech intelligible to strangers
Pediatric hearing loss is associated with what abnormality
Speech delay
What is the purpose of pneumatic otoscopy?
Assess TM mobility
By ___ years old speech should be completely intelligible
4 years
Final primary teeth have erupted at ____ months
24
Teeth eruption is _____ and the first teeth are _____
bilaterally symmetrical and central incisors at 6-10 months
Normal heart rate:
- birth
- 3 years
- 6 years
- birth: 110-160 bpm
- 3 years: 80-120 bpm
- 6 years: 70-110 bpm
What is the purpose of measuring blood pressure in all 4 extremities in the newborn period
-coarctation of the aorta
If suspected coarctation of the aorta you should:
-check and compare femoral and brachial pulses
Routine BP screening should begin at age:
- 3 years
- Use table based on age, height and gender
Dyslipidemia screening via risk assessment starts at:
-age 2, 4, 6, 8 , 10 then annually
By ____ to ___ years should have a fasting lipid profile
18-21
A bilirubin level >____ is termed hyperbilirubinemia
> 5mg/dL
Kernicterus is
What happens in an infants brain when bili levels rise, bilirubin deposits in the brain and it results in neurological dysfunction
Bilirubin usually peaks in full-term infants on day ___ or ____
In preterm infants it peaks on day ____ or _____
3 to 4; 5 to 7
Where should the examiners 2nd-5th fingers be placed to perform Ortolani’s test
-On the greater trochanter
Barlow’s
2nd - 5th fingers over greater trochanter; internally rotate hip if DD hip will dislocate towards butt
Ortolani’s
Externally rotate hip to check for DDH
Positive galeazzi
-uneven knee height (developmental hip dysplasia until proven otherwise)
What is talipes equinovarus
club foot
Scoliosis Dx tests
Full length PA and lateral standing or scoliosis series
Cobb method
measures angle of spine for scoliosis; consider referral for >20 degrees
Tanner stage 1
prepubertal
Tanner stage 5
adult
Tanner stage 2 females
- Breast buds (thelarche)
- Breast and papilla form small mound, areola increase in diameter
- few straight fine hairs
Tanner stage 3 females
- Breasts and areola enlarge, one mound, no separation in contours
- pubic hair: darker, coarse starts to curl
Tanner stage 4 females
- secondary mound formed by areola and papilla about at level of breast
- thicker, curly, darker coarse pubic hair
Tanner stage 2 males
- slight testicular enlargement, scrotum reddened and textured
- few straight fine hairs
Tanner stage 3 males
- lengthening of penis,
- pubic hair: darker, coarse starts to curl
Tanner stage 4 males
- penis thickens
- thicker, curly, darker coarse pubic hair
The correct order of maturation regarding hair development in males is
-pubic, axillary and then facial hair
The earliest secondary sexual characteristic in girls is
Thelarche or the onset of breast development
The earliest secondary sexual characteristic in males is
-testicular volume
What drugs can cause gynecomastia in young males:
- pot
- aldosterone
- tegamet
How long after acute overdose of acetaminophen is the serum concentration accurrate
4 hours
Presentation of testicular torsion
- abrupt onset
- unilateral testicular pain
- radiation to lower abdomen or groin
- nausea
- vomiting
- scrotal edema
- redness
- absent ipsilateral cremasteric reflex
Testicular pain presents like
- heaviness in scrotum
- hardened mass
- usually painless
Hodgkin Lymphoma presentation
- enlarged and painless cervical, axillary, groin or supraclavicular lymphadenopathy
- fever
- fatigue
- weight loss
- night sweats
- severe pain on or over malignant areas after drinking ETOH
Top 3 causes of death in adolescents
- accidents
- suicide
- homicide
Precocious puberty is if puberty starts before ____ years in females and ____ years in males
8 years in females and 9 in males
Delayed puberty is considered if no breast development by ____ years and no testicular enlargement by ____ years
12 years and 14 years
Mittelschmerz is
Ovulation pain
The most fertile period in the cycle is about 3 days before and during ovulation
11-14 days
Antedote of tylenol posiion is
IV N-acetylcysteine
No parental consent is needed for
- contraception
- STD testing
- pregnancy
What are labs for delayed puberty
- preg test
- prolactin level
- FSH, LH,
- TSH
Primary amenorrhea is
no menarche by 15 years in the presence of normal growth and secondary sex characteristic
Secondary amenorrhea is
no menses for more than 3 cycles or 6 months in a woman who had previous menses
What is the female athlete triad
- anorexia nervosa
- amenorrhea
- osteporosis
What are labs for amenorrhea
- preg test
- prolactin
- TSH
- FSH
- LH
- Bone density
In the female athletic triad educate
- increasing caloric intake
- vit D 1,200 to 1,500 and vit E
What are complications of amenorrhea
- osteopenia/osteoprosis
- fertility issues
What a clinical findings of anorexia
- marked weight loss (BMI <18.5)
- lanugo
- osteoprosis/osteopenia
- swollen feet (low albumin)
- dizziness
- abdominal bloating
What is gynecomastia
excessive growth of breast tissue in males
What are findings in a male with gynecomastia
-round, rubbery, and mobile mound (dislike) under the areola of both breast
What is involved in the treatment plan of gynecomastia
- evaluate for tanner staging
- check for drug use (steroid, cimetidine, antipsych)
- rule out serious etiology (testicular or adrenal tumors, brain tumor, hypogonadism)
- recheck in 6 months
What is pseudogynecomastia
-bilateral enlarged breast r/t fatty tissue
-both breast are soft to touch
0non tender
-no breast bud or dislike breast tissue
What is the screening test for scoliosis
adam’s forward bend test
- bend forward with arms hanging free
- look for asymmetry of spin, scapula, thoracic and lumbar curvature
A cobb curve between 20-40 is managed by
Bracing
A cobb curve <20 is managed by
Monitoring
How is a cobb curve >40 managed
surgery
What is the diagnostic test for scoliosis
PA x-ray
What is osgood-schlatter disease
-a common cause of knee pain in young athletes
What is the cause of osgood-schlatter
-overuse of the knee, repetitive stress on the patellar tendon by the quadricept muscle
what is the presentation of osgood schlatters
- tender, bony mass over the anterior tubercle
- pain is worsened by some activities
- pain is relieved by rest
What is the treatment plan of osgood-schlatter
RICE
- Ice 10-15 minutes 3x.day
- avoid aggravating activities
- play does not worsen activities
- Quad strengthening
- NSAIDs/Tylenol
What is klinefelters syndrome
A condition in which males are born with an extra X chromosome
What is the presentation of Klinefelter’s
- testicles are small and firm
- penis is small
- tall stature
- wider hips
- reduced facial and body hair
- high risk of osteoporosis
What is the tx Klinefelters
-testosterone replacement and fertility treatment
What is Turner’s syndrome
-females with complete or partial absence of the 2nd sex chromosome
What is the presentation of Turner’s syndrome
- congenital lymphedema of hands, feet
- webbed neck
- high-arched palate
- short 4th metacarpal
- short stature
- ovarian failure
- cardiovascular/renal issues
- ear malformation
- amenorrhea
General precautions with any childhood vaccine
- moderate or severe acute illness with or without fever
- especially fever >100.4
Hepatitis A vaccine is universally recommended at ____ years and how many doses at what dosing interval
- universally recommended for all children at age 1 year
- 2 doses should be 6 months apart
What is the schedule for Hepatitis B vaccine
3 dose series at: 0, 1-2 months, 6 months after the first
-only immunization at birth
Tdap starts at age
- 7 years and up
- Get a booster at 11-12
Live attenuated vaccines common side effects are
- fever
- rash
No live or attenudated vaccines before ____ years or age
1 year
MC4 vaccine should be admistered
- to all children ages 11-12 or 13-18 years if not previously vaccinated
- Booster at age 16
A common reaction with the HPV, MCV4 and Tdap is syncope this is an example of a:
a) localized reaction
b) systemic
c) allergic
b) Systemic
Spacing of vaccines: A vaccine given ___ days prior to the scheduled time to receive is considered at valid dose
4 days
A 4 year old is scheduled to receive her varicella immunization today. What may be a contraindication to receiving the vaccine today?
a) She is receiving allergy shots
b) on tamiflu for flu prophylaxis
c) she is taking amoxicillin
-she is on tamiflu for flu prophylaxis
what is CDC’s recommendation for length of time to monitor a child after immunization?
15 minutes
A month reports that her 1 year old has an allergy to eggs that produces a non-pruritic rash. Which immunizations are contraindicated ?
none
When you give a live or attenuated vaccines you should give them on the same day, if not, you must wait _____ weeks to give the one you didn’t give. Why is that
4 weeks; because if you don’t neither immunization will produce a protective titre
ADHD DSM-5 criteria
- Symptoms present prior to 12 years of age
- Symptoms last >6 months
- Be evident in 2 or more settings
- 6+ sx of inattention
- 6+ sx of hyperactivity and inactivity
What are the 2 notable exceptions to asthma management in children compared with adults
- Use of LTRA (singulair)
- The way the drug is administered (neb or spacer)
The most common pathogen for pneumonia in children 6 months to 5 years
Viral
Immunization via PCV13 at 2,4,6 and 12-15 months helps prevent
Drug resistant strep pneumo
Most sensitive sign of pneumonia in children is
-increased respiratory rate
What is management of bacterial pneumonia in children
- high dose amoxcillin 90g/kg/day
- If pen allergic: Macrolide/clindamycin
What is the presentation of bronchiolitits
- self limited
- paroxysmal wheezing
- increased respiratory rate
- fever
- cough
What is the management of bronchiolitis
- Self limiting, supportive care
- unless they have serious resp symptoms (ER)
A 3 year old child presents with barky cough, no stridor and mild retractions how is this managed
- single dose of oral dexamethasone (0.6mg/kg)
* has a long 1/2 life
Welsey croup score criteria
- retractions
- stridor
- cyanosis
- LOC
- air entry
What sx might be present in the child who has suspected CF
- recurrent pulmonary infections
- weight loss
- greasy stools
What are symptoms of lead toxicity
- fatigue
- GI (constipation, stomach)
- irritability
What are the most common presenting signs of leukemia
- fever (evening)
- bleeding
- bone pain
- lymphadenopathy
- fatigue
Rule about nodes
> 10mm is enlarged
Exception:
- epitrochlear enlarged if >5mm
- inguinal enlarged if >15mm
- Cervical enlarged if >20mm
How do you manage encopresis
- laxatives for initial cleansing (PEF, Miralax) then daily until normal stools
- behavior changes (sit for 5 minutes 2-3x daily after meals to establish normal BMs)
- Reward systems
- Goal is 1 soft stool daily
- dietary changes: fiber, fluids
*taper laxatives gradually after daily bowel movements
Viral Gasto rehydration
50-100ml/kg over 4 hours
*Pale yellow urine signifies hydration
Heart rate and dehydration
Mild- normal
Moderate- rapid
severe - rapid and weak
When should a patient with cryptorchidism be referred to urology
6 months of age
A 9 month old has a hydrocele what advise should you give to a caregiver?
-it should resolve by 9 months
What is the most common cause of a persistent hydrocele?
-hernia
What is the most common cause of pediatric UTIs
-vesicourethral reflux
UTIs are aggressively treated in infants to prevent
- pyelonephritis
- renal scarring
- hypertension
- end-stage renal dysfunction
How do you manage pediatric UTIs
- treat empircally
- get a urine C&S
- Give 3rd general cephalosporin x 3-5 days if afebrile; 10 days if febrile
Imaging for pediatric UTI
- renal and bladder ultrasound for all infants 2-24 months
- voiding cystourethrogram test of choice for vesicourethral reflux
What is kawasaki’s disease
acute generalized systemic vasculitis of the medium-sized vessels
What dx should you order for kawasaki
- CBC
- ESR
- CRP
- ALT/AST
- Echo
What are the characteristics of innocent murmurs
- grade 2 or less
- soft
- not holosystolic
- minimal radiation
- musical/vibratory
- movement makes it go away
- child is on their growth chart
Nursemaid’s elbow is the result of a
pull injury; annual ligament slips over the head of the radius and becomes trapped
What term describes the pain in osgood schlatters
-osteochondritis
At what age does osgood schlatters disease most often occur
9-14
-often after a big growth spurt
Pain with osgood schlatter can last
6-18 months
The management of osgood schlatter
- continuation of activity as pain tolerates
- ice
- analgesics as needed
What is Legg-calve-perthes disease
Osteonecrosis of the capital femoral epiphysis due to interrupted vascular supply
How does legg-calve-perthes present
- pain to hip or referral to medial aspect of the knee
- limp
- pre pubescent children
What exam will you do for evaluating hip abnormalities
Trendelenburg
What is a positive trendelenburg
-asking child to stand on affected side causes a pelvic tilt
When is trendelenburg positive
-SCFE, legg-calve perthes disease and developmental dysplasia of the hip
What imaging should you get in hip pain
-AP and frog-leg
What is the presentation slipped capital femoral epiphysis
- hx of several week or months of hip/knee pain with limp
- in adolescents
- trendlenburg
Transient synovitis of the hip
benign condition causing acute limp and hip pain in children
- will have had an URTI in 7-14 prior
- negative trendelenburg
This maculopapular brick red rash starts on the head and neck and spread through trunk and extremities
Measles (Rubeola)
This illness causes a slapped cheek, lacy, macular rash
Fifths disease; erythema infectiosum
High fever for 2-4 days then abrupt cessation of fever with appearance of maculopapular rash but not on face
roseola
For all viral exanthums except chickenpox when can kids return to school or daycare
-24 hours after afebrile
Exotoxin rash secondary to group A strep infection, sandpaper like rash that desquamates
Scarlet fever
What is the presentation of mealses
- Koplik spots
- Fever
- Malaise
- 3 C’s (conjunctivitis, coryza and cough)
