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AANP Study Cards > Peds > Flashcards

Peds Flashcards

1
Q

What is failure to thive

A

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

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2
Q

What are the causes of FTT

A
  • inadequate dietary intake
  • Diarrhea
  • Malabsorption (celiac, CF, food allergies)
  • poor maternal bonding
  • frequent infections
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3
Q

What is Down Syndrome

A

A genetic defect caused by trisomy of chromosome 21

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4
Q

What are features of Down Syndrome

A
  • 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
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5
Q

Down syndrome increases the risk of

A
  • intellectual disability
  • congenital heart defects
  • feeding difficulties
  • congenital hearing loss
  • thyroid disease
  • cataracts
  • sleep apnea
  • early onset alzheimers
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6
Q

What are the classic features of fetal alcohol syndrome

A
  • 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
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7
Q

When do symptoms of gonococcal ophthalmia neonatorum

A

2-5 days after birth

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8
Q

What is the concern with gonococcal ophthalmia neonatorum

A

blindness

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9
Q

What are sx of gonococcal ophthalmia neonatorum

A
  • injected conjunctiva with profuse purulent discharge

- swollen eyelids

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10
Q

Any neonate with acute conjunctivitis within 30 days or less of birth should be tested for:

A
  • Chlamydia
  • Gonorrhea
  • HSV
  • Bacterial infection
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11
Q

What tests should you order for a neonate with suspected gonococcal ophthalmia neonatorum

A
  • Gram Stain

- Gonococcal culture or PCR

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12
Q

How do you treat gonococcal ophthalmia neonatorum

A
  • Hospitalize

- High dose IV/IM Cefotaxime

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13
Q

When do symptoms of chlamydial ophthalmia neonatorum present

A

4-10 days after birth

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14
Q

What are sx of chlamydial ophthalmia neonatorum

A
  • edematous eyelids
  • redness
  • watery discharge that may become purulent
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15
Q

How is chlamydial ophthalmia neonatorum treated?

A

-Erythromycin QID x 14 days

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16
Q

What is Sudden Infant Death Syndrome

A

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

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17
Q

What are risk factors for SIDS

A
  • Prematurity
  • Low birth weight
  • Maternal smoking/drug use
  • Poverty
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18
Q

How can you decrease the risk of SIDS

A
  • 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
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19
Q

When should neonatal weight loss be regained after birth

A

10-14 days

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20
Q

What are signs of severe dehydration in infants

A
  • weak and rapid pulse
  • tachypnea
  • deep breathing
  • parched mucous membranes
  • markedly sunken anterior fontanelle
  • tenting skin turgor
  • cool skin
  • acrocyanosis
  • anuria
  • changes in LOC
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21
Q

A blue to black colored patch or stain most commonly on the lumbosacral area in newborns of native American, hispanic and black ethnicity

A

Mongolian spot or Congenital dermal melanocytosis

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22
Q

Multiple white 1-2 mm papules located on the forehead, cheeks and nose of neonates

A

-Milia or Miliaria

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23
Q

What is seborrheic dermatitis

A

-excessive thick scaling on the scalp of young infants

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24
Q

Hows is seborrheic dermatitis treated

A
  • soaking scalp with vegetable or mineral oil
  • mild baby shampoo
  • removing scales with soft brush or comb
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25
Q

What is a faun tail nevus and what can it be a sign of?

A
  • Tufts of fair overlying the spinal column usually at the lumbosacral area
  • Can be a sign of neural tube defects
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26
Q

What test should you order in a baby with a faun tail nevus

A

Ultrasound to rule out occult spina bifida

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27
Q

Flat light brown to dark brown spots >5mm

A

Cafe-au-lat spots

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28
Q

If you have >6 cafe-au-lait spots larger than 5mm what do you need to rule out

A

Neurofibromatosis or von Recklinghausen’s

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29
Q

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

A

Nevus simplex or stork bites

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30
Q

Neonates with pink to red, flat, stain like skin lesion. Blanches to pressure, irregular in shape and size. Unilateral are

A

Port wine stain

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31
Q

What do you need to rule out in a baby with a port wine stain?

A
  • Trigeminal nerve involvement

- Sturge-Weber syndrome

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32
Q

Raised vascular lesion ranging in size form 0.5-0.4cm, bright red in color, soft to touch.

A

Hemangioma

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33
Q

When do hemagiomas resolve?

A

-most involute gradually over 1-5 years

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34
Q

At 1 month visual screening includes that an infant ca

A

Briefy fixate on mom’s face

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35
Q

At 3 months visual screening includes that an infant will

A

Hold their hands close to their face and observe them, will fixate on a toy or object

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36
Q

At 6 months visual screening includes that an infant will

A

Make good eye contact

Turn head to scan 180 degree visual field

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37
Q

At 12 months visual screening includes that an infant will

A

Make prolonged eye contact when spoken to

-recognizes self in mirror and favorite people from a distance

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38
Q

What is stabismus

A

Misalignment of the eye

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39
Q

What is esotropia

A

Inward turning of the eye

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40
Q

What is exotropia

A

Outward turing of the eye

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41
Q

What are the risks of uncorrected strabismus

A
  • permanent vision loss

- abnormal vision (diploia)

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42
Q

What are the treatment options for strabismus

A
  • Eye glasses
  • eye exercises
  • prism
  • eye surgery
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43
Q

Indications for referral to peds opthalmology

A
  • 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
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44
Q

What can a white color on the check for a red reflex signify

A
  • cataracts
  • retinoblastoma
  • leukocoria
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45
Q

What does the corneal light reflex or Hirschberg test screen for

A

Strabismus

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46
Q

HEARS for hearing loss

A
  • Hyperbilirubinemia
  • Ear infections (frequent)
  • Apgar scores (low)
  • Rubella, Cytomegalovirus, toxoplasmosis
  • Seizures

*Also preterm infants are at greater risk

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47
Q

PKU is

A

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

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48
Q

Healthy infants have enough iron stores to last up to ___ months

A

6 months

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49
Q

Vitamin D drops should be given to breastfed babies at ____ dose

A

400 IU

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50
Q

Avoid cows milk in the 1st ____ of life because of the risk of _____

A

12 months; GI bleeds

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51
Q

Wait until ____ months to introduce solid foods and start with ____

A

4-6 months; iron fortified cereals

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52
Q

Introduce 1 food at a time for ___ to ___ days

A

4-5 days

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53
Q

Failure to pass meconium within ____ hours is concerning`

A

24

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54
Q

Head circumference will increase by ____cm in the first 12 months of life

A

12

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55
Q

What is a difference between caput succedaneum and cephalohematoma

A

-a cephalohematoma does not cross the suture line

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56
Q

Infants between 0-6 months growth includes a weight gain of ____/week and height of _____/month

A
  • 6-8oz/week

- 1 inch/month

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57
Q

Infants between 6-12 months growth includes a weight gain of ____/week and height of _____/month

A
  • 3-4oz/week

- 1/2 inch/month

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58
Q

Symptoms of teething

A
  • fever
  • drooling
  • chewing on objects
  • irritability
  • crying
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59
Q

First teeth erupt between ___ to ___ months and are the _____ teeth

A

6-10 months; lower central incisors

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60
Q

Kids have their full set of primary teeth by

A

2.5 years

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61
Q

First permanent teeth erupt by age

A

6

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62
Q

Epispadias is

A

when the urethral meatus is on the dorsal aspect of the penis

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63
Q

Hypospadias is

A

when the urethral meatus is on the ventral aspect of the penis

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64
Q

Birth weight ___ by 6 months and ___ by 12 months

A

Doubles by 6 months, triples by 12 months

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65
Q

Anal wink reflex

A

stroke anal region and look for perianal muscle contraction

-If absent: abnormal suggests spinal cord lesion

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66
Q

Plantar reflex or babinski

A

Upward extension of the big toe with fanning

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67
Q

Palmar reflex

A

Infant will close its hand around the finger

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68
Q

Moro reflex

A

Startle, sudden loud noise will cause symmetrical abduction and extension of the arms followed by adduction and flexion of the arms over the body

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69
Q

A strong moro in an older infant beyond ____ months of age is

A

6 months is abnormal and indicative of brain damage

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70
Q

When should the moro reflex disappear

A

3-4 months

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71
Q

Step reflex

A

Holding baby upright allow the dorsal surface of 1 foot to touch the edge of the table. baby will simulate a stepping motion

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72
Q

When does the step reflex disappear

A

6 weeks

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73
Q

Tonic neck reflex

A

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

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74
Q

Rooting reflex

A

Stroking corner of mouth causes sucking

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75
Q

When does rooting reflex disappear

A

3-4 months

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76
Q

When does an infant first get an MMR-V vaccine

A

12 months; 2nd dose at 4-6 years

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77
Q

When does an infant first get an influenza shot

A

6 months

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78
Q

What are contraindications to the influenza vaccine

A

<6 mths old

  • severe egg allergy
  • moderate to severe illness with fever (wait until better)
  • Hx of GBS
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79
Q

DT is used for

A

Infants and children <7

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80
Q

Tdap is used at what ages

A

for ages 7 and older

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81
Q

What are SE of DTaP or DT

A
  • Fever
  • swelling, pain, redness at site of injection
  • irritability
  • acute encephalopathy
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82
Q

By 15-18 month the following vaccines are usually complete for most infants

A
  • Hep B (3 doses)
  • Hib
  • PCV 13 (4 doses)
  • Rotavirus (2-3 doses)
  • Hep A (2 doses)
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83
Q

Give Tdap at age ___

A

11-12

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84
Q

At 2 months old a baby can

A
  • Follow objects past midline
  • coo vowels
  • lifts head when prone
  • smiles in response to others
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85
Q

At 4 months old a baby can

A
  • smile sponatenously
  • babbles
  • hands to mouth
  • holds head steady
  • rolls front to back (supine to prone)
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86
Q

At 6 months old a baby can

A
  • 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)
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87
Q

At 9 months old a baby can

A
  • 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
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88
Q

At 12 months old a baby can

A
  • use a sippy cup
  • stand independenly
  • start to cruise
  • can say 1-2 words
  • knows name
  • follows simple commands
  • growth rate slows
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89
Q

At 15 months old a toddler can

A
  • feed self with spoon
  • drink from a cup
  • walk independently for longer distances
  • follow commands
  • vocab of 4-6 words
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90
Q

At 18 months old a toddler can

A
  • turn pages of a book
  • walk up step
  • point to 4 body parts
  • vocab of 10-20 words
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91
Q

Rear facing car seat is recommended up to the age of

A

2

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92
Q

What is hyperbilirubinemia

A

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

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93
Q

Jaundice in the 1st ____ hours of life is always _____

A

24hrs is always pathologic

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94
Q

Pathologic jaundice should be evaluated for

A
  • sepsis
  • TORCH
  • occult hemorrhages
  • erythroblastosis fetalis
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95
Q

What is the treatment plan for neonatal jaundice

A
  • 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
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96
Q

What is a complication of hyperbilirubinemia

A

Bilirubin encephalopathy (kernicterus)

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97
Q

What is physiologic anemia of infancy

A

Hemoglobin drops to its lowest level 8-12 weeks of age

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98
Q

What are sx of congenital lacrimal duct obstruction

A
  • persistant tearing
  • eyelash matting
  • no conjunctival erythema
  • reflux of mucoid discharge when lacrimal duct palpated
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99
Q

Sx of Acute dacryocystitsis

A
  • redness
  • warmth
  • tenderness
  • swelling
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100
Q

Rule of 3’s for colic

A
  • 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

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101
Q

Coarctation of the aorta

A

narrowing of a portion of the aorta

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102
Q

How to screen for coarctation of the aorta

A

-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
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103
Q

What is Barlows maneuver

A

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
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104
Q

What is ortolani

A
  • hold each knee and place finger over the greater trochanter. rotate hips in the frog leg position
    • is a click or clunk
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105
Q

An asymmetric gluteal or thigh fold suggests

A

DD of the hip

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106
Q

What is the presentation of neuroblastoma

A
  • 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
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107
Q

What is the most common site of a neuroblastoma

A

-Adrenal medulla

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108
Q

What are the diagnostic tests for neuroblastoma

A
  • urinary catecholamines

- ultrasound

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109
Q

What is the presentation of a nephroblastoma

A
  • asymptomatic abdominal mass that extends from the flank toward the midline
  • non tender and smooth mass
  • rarely crosses the midline
  • abdominal pain
  • hematuria
  • hypertension
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110
Q

What is the dx test for nephroblastoma

A

-ultrasound

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111
Q

What is the presentation of epiglottis

A
  • acute onset of high fever, -chills
  • muffled hot potato voice
  • anxiety
  • stridor
  • tripoding
  • tachycardia
  • tachypnea
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112
Q

Where do osteomyelitis typically occur

A

at the metaphyses

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113
Q

What is the presentation of septic arthritis

A
  • abrupt onset of unilateral hip or knee pain
  • swelling
  • warmth
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114
Q

What is the presentation of orbital cellulitis

A
  • abrupt onset of deep eye pain that is aggravated bye eye movements
  • high fever
  • chills
  • bulging eye
  • abnormal extraocular eye movements
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115
Q

Orbital cellulitis is more likely to be caused by _____ sinusitis as opposed to ____ or _____ sinusitis

A

ethmoid

-frontal or maxillary

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116
Q

What is preseptal cellulitis

A

an infection of the anterior portion of the eyelid that dose not involve the orbit/globe of the eye

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117
Q

What are red flags for non-accidental trauma or child abuse

A
  • posteriomedial rib fracture
  • metaphyseal avulsion fracture
  • bruises or fractures in various stages of healing
  • delay in seeking medical care
  • injuries inconsistent with the story
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118
Q

What are the top 3 causes of death in ages 1-4

A
  • drowning
  • congenital anomalies
  • MVA
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119
Q

What are the top 3 cancers

A
  • leukemia
  • brain and nervous system tumors
  • lymphomas
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120
Q

By 9 months if infantile reflexes remain strong this is considered

A

abnormal

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121
Q

At 1 a child can

A
  • support own weight
  • walk with hands help
  • starts to cruise
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122
Q

At 2 years old a child can

A
  • 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
123
Q

At 3 years old a child can

A
  • 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
124
Q

At 4 years old a child can

A
  • copy a cross
  • draw a person with 3 body parts
  • plays mom and dad
  • hops and stands on 1 foot
  • names colors and numbers
125
Q

At 5 years old a child can

A
  • draw a person with 6 body parts
  • counts 10 or more
  • aware of gender
  • copy a square
  • ride a bike
  • dress and undress self
126
Q

Red flags for autistic behavior are

A
  • 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
127
Q

What are clues that a child is ready for toilet training?

A
  • 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
128
Q

Most children are ready for potty training at ____ to ___ months, but some children may not be ready until ____ months

A

18-24 months; 36 months

129
Q

5 behaviors to look for with autism

A
  • 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
130
Q

What are the sx of kawasaki disease

A

WARM CREAM

  • Fever >5 days
  • Conjunctivitis
  • Rash: erythematous, maculopapular, morbiliform
  • Erythema/Edema (palms and soles)
  • Adenopathy, cervical
  • Mucous membranes (strawberry tongue, dry & red)
131
Q

What is the treatment of kawasaki disease

A

-IVIG and high-dose aspirin

132
Q

What are sx of leukemia

A
  • extreme fatigue
  • weakness
  • pallor
  • easy bruising
  • petechiae
  • bleeding gums
  • nose bleeds
  • bone/joint bain
  • lymphadenopathy
  • abdominal swelling
133
Q

The most common cancer in children is ____ and the most common type is ____

A

leukemia and ALL

134
Q

What is ALL

A
  • most common form of leukemia

- fast growing cancer of the lymphoblasts (immature lymphocytes

135
Q

What is AML

A

-Fast growing cancer of the bone marrow that affects immature or precursor blood cells such as myeloblasts, monoblasts, erythroblasts and megakaryobalsts

136
Q

What is reye’s syndrome

A
  • 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

137
Q

Atlantoaxial instability is a risk in

A

Down syndrome

138
Q

Absence seizures are

A

brief episodes when a child stops what they are doing

-may be described as daydreaming and inattentive

139
Q

What is a still’s murmur

A
  • 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
140
Q

Top causes if death ages 5-9

A
  • malignant neoplasm
  • MVA
  • Congenital abnormalities
141
Q

Piaget stages of cognitive development

A

1) Sensorimotor- birth to 2
2) Preoperational- 2-7 year
3) Concrete operational- 7-11 year
4) Formal Operational- 12 year to adulthood

142
Q

What is autism spectrum disorder

A

-neurodevlopmental disorder that affects the normal development of communication and social skills

143
Q

What is a classic case of autism spectrum disorder

A
  • 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
144
Q

What medication may be helpful in autism spectrum

A

-risperidone

145
Q

What is the presentation of fragile x syndrome

A
  • 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
146
Q

What is the cause of hand foot and mouth disease

A

coxsackievirus A16

147
Q

What are the sx of hand foot and mouth disease

A
  • fever
  • sore throat
  • headache
  • anorexia
  • multiple small blisters on the hands feet and rectum and in the mouth
148
Q

What is the treatment for hand foot and mouth disease

A

-symptomatic

149
Q

Multiple small blisters appearing on the hands, feet, rectum and small ulcers in the mouth, throat, tonsils and tongue

A

hand foot and mouth

150
Q

honey colored crusted lesions

A

impetigo

151
Q

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

A

Mealses or rubeola

152
Q

Generalized rash in different stages: Papules –> vesicles –> pustules –> crusts. Pruritic. Very contagious

A

Varicella

153
Q

Sandpaper rash with sore throat, strawberry tongue

A

-scarlet fever

154
Q

Ovoid white nits on hair, red papules that are itchy and nits in the hairline

A

Pediculosis capitis (head lice)

155
Q

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

A

Mollouscum contagiosum

156
Q

Maculopapular rash located in interdigital webs of hands, feet, waist, axillae, groin, very pruritic, can resemble pimples eczema and insect bite

A

Scabies

157
Q

Presentation of functional constipation (encopresis)

A
  • 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
158
Q

What is a diagnostic test to assist with functional constipation

A

X-ray

159
Q

All 11-12-year-olds should be vaccinated with a single dose of

A
  • Quadrivalent meningococcal vaccine (MenACWY) or Menactra and menveo
  • Tdap
  • HPV (if not already given)
160
Q

HPV can be given as young as ____ and as old as _____

A

9 and 26

161
Q

Child at the age of 11 years is in the _____ thinking of piagets theory

A

Early abstract

162
Q

Fetal nutrition is best assessed by:

A
  • hydration status
  • weight
  • subcutaneous fat on the anterior thighs and gluteal region
163
Q

Anterior fontanelle should close between ____ and ____ months

A

9 & 18 months

164
Q

Is Posterior fontanelle always open at birth

A

No

165
Q

If the posterior fontanelle is open at birth when should it close by?

A

2 months

166
Q

Hyperteiorism means

A

eyes are far apart

167
Q

Low set ears may indicated renal

A

agenesis

168
Q

A webbed neck may be associated with

A 
turners syndrome
(redundant skin along the posterolateral line)
169
Q

Consider iron supplementation at ___ months

A

6 months

170
Q

Eye evaluation for:

  • Newborn to 3 months:
  • 3-6 months
  • 6-12 months
  • > 3 years
A
  • 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
171
Q

At what age should eye alignment occur

A

-between 2-4 months of age

172
Q

What is amblyopia

A

Loss of vision

173
Q

The corneal light reflex and cover/uncover tests are used to assess:

A

Strabismus

*start at 6 months-3 years

174
Q

Children should have 20/20 by

A

6 years

175
Q

hearing evaluation by age:

  • Newborn to 3 months
  • 3 to 6 months
  • 6-12 months
  • 12-18 months
  • 18-24 months
A
  • 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
176
Q

Pediatric hearing loss is associated with what abnormality

A

Speech delay

177
Q

What is the purpose of pneumatic otoscopy?

A

Assess TM mobility

178
Q

By ___ years old speech should be completely intelligible

A

4 years

179
Q

Final primary teeth have erupted at ____ months

A

24

180
Q

Teeth eruption is _____ and the first teeth are _____

A

bilaterally symmetrical and central incisors at 6-10 months

181
Q

Normal heart rate:

  • birth
  • 3 years
  • 6 years
A
  • birth: 110-160 bpm
  • 3 years: 80-120 bpm
  • 6 years: 70-110 bpm
182
Q

What is the purpose of measuring blood pressure in all 4 extremities in the newborn period

A

-coarctation of the aorta

183
Q

If suspected coarctation of the aorta you should:

A

-check and compare femoral and brachial pulses

184
Q

Routine BP screening should begin at age:

A
  • 3 years

- Use table based on age, height and gender

185
Q

Dyslipidemia screening via risk assessment starts at:

A

-age 2, 4, 6, 8 , 10 then annually

186
Q

By ____ to ___ years should have a fasting lipid profile

A

18-21

187
Q

A bilirubin level >____ is termed hyperbilirubinemia

A

> 5mg/dL

188
Q

Kernicterus is

A

What happens in an infants brain when bili levels rise, bilirubin deposits in the brain and it results in neurological dysfunction

189
Q

Bilirubin usually peaks in full-term infants on day ___ or ____

In preterm infants it peaks on day ____ or _____

A

3 to 4; 5 to 7

190
Q

Where should the examiners 2nd-5th fingers be placed to perform Ortolani’s test

A

-On the greater trochanter

191
Q

Barlow’s

A

2nd - 5th fingers over greater trochanter; internally rotate hip if DD hip will dislocate towards butt

192
Q

Ortolani’s

A

Externally rotate hip to check for DDH

193
Q

Positive galeazzi

A

-uneven knee height (developmental hip dysplasia until proven otherwise)

194
Q

What is talipes equinovarus

A

club foot

195
Q

Scoliosis Dx tests

A

Full length PA and lateral standing or scoliosis series

196
Q

Cobb method

A

measures angle of spine for scoliosis; consider referral for >20 degrees

197
Q

Tanner stage 1

A

prepubertal

198
Q

Tanner stage 5

A

adult

199
Q

Tanner stage 2 females

A
  • Breast buds (thelarche)
  • Breast and papilla form small mound, areola increase in diameter
  • few straight fine hairs
200
Q

Tanner stage 3 females

A
  • Breasts and areola enlarge, one mound, no separation in contours
  • pubic hair: darker, coarse starts to curl
201
Q

Tanner stage 4 females

A
  • secondary mound formed by areola and papilla about at level of breast
  • thicker, curly, darker coarse pubic hair
202
Q

Tanner stage 2 males

A
  • slight testicular enlargement, scrotum reddened and textured
  • few straight fine hairs
203
Q

Tanner stage 3 males

A
  • lengthening of penis,

- pubic hair: darker, coarse starts to curl

204
Q

Tanner stage 4 males

A
  • penis thickens

- thicker, curly, darker coarse pubic hair

205
Q

The correct order of maturation regarding hair development in males is

A

-pubic, axillary and then facial hair

206
Q

The earliest secondary sexual characteristic in girls is

A

Thelarche or the onset of breast development

207
Q

The earliest secondary sexual characteristic in males is

A

-testicular volume

208
Q

What drugs can cause gynecomastia in young males:

A
  • pot
  • aldosterone
  • tegamet
209
Q

How long after acute overdose of acetaminophen is the serum concentration accurrate

A

4 hours

210
Q

Presentation of testicular torsion

A
  • abrupt onset
  • unilateral testicular pain
  • radiation to lower abdomen or groin
  • nausea
  • vomiting
  • scrotal edema
  • redness
  • absent ipsilateral cremasteric reflex
211
Q

Testicular pain presents like

A
  • heaviness in scrotum
  • hardened mass
  • usually painless
212
Q

Hodgkin Lymphoma presentation

A
  • 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
213
Q

Top 3 causes of death in adolescents

A
  • accidents
  • suicide
  • homicide
214
Q

Precocious puberty is if puberty starts before ____ years in females and ____ years in males

A

8 years in females and 9 in males

215
Q

Delayed puberty is considered if no breast development by ____ years and no testicular enlargement by ____ years

A

12 years and 14 years

216
Q

Mittelschmerz is

A

Ovulation pain

217
Q

The most fertile period in the cycle is about 3 days before and during ovulation

A

11-14 days

218
Q

Antedote of tylenol posiion is

A

IV N-acetylcysteine

219
Q

No parental consent is needed for

A
  • contraception
  • STD testing
  • pregnancy
220
Q

What are labs for delayed puberty

A
  • preg test
  • prolactin level
  • FSH, LH,
  • TSH
221
Q

Primary amenorrhea is

A

no menarche by 15 years in the presence of normal growth and secondary sex characteristic

222
Q

Secondary amenorrhea is

A

no menses for more than 3 cycles or 6 months in a woman who had previous menses

223
Q

What is the female athlete triad

A
  • anorexia nervosa
  • amenorrhea
  • osteporosis
224
Q

What are labs for amenorrhea

A
  • preg test
  • prolactin
  • TSH
  • FSH
  • LH
  • Bone density
225
Q

In the female athletic triad educate

A
  • increasing caloric intake

- vit D 1,200 to 1,500 and vit E

226
Q

What are complications of amenorrhea

A
  • osteopenia/osteoprosis

- fertility issues

227
Q

What a clinical findings of anorexia

A
  • marked weight loss (BMI <18.5)
  • lanugo
  • osteoprosis/osteopenia
  • swollen feet (low albumin)
  • dizziness
  • abdominal bloating
228
Q

What is gynecomastia

A

excessive growth of breast tissue in males

229
Q

What are findings in a male with gynecomastia

A

-round, rubbery, and mobile mound (dislike) under the areola of both breast

230
Q

What is involved in the treatment plan of gynecomastia

A
  • 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
231
Q

What is pseudogynecomastia

A

-bilateral enlarged breast r/t fatty tissue
-both breast are soft to touch
0non tender
-no breast bud or dislike breast tissue

232
Q

What is the screening test for scoliosis

A

adam’s forward bend test

  • bend forward with arms hanging free
  • look for asymmetry of spin, scapula, thoracic and lumbar curvature
233
Q

A cobb curve between 20-40 is managed by

A

Bracing

234
Q

A cobb curve <20 is managed by

A

Monitoring

235
Q

How is a cobb curve >40 managed

A

surgery

236
Q

What is the diagnostic test for scoliosis

A

PA x-ray

237
Q

What is osgood-schlatter disease

A

-a common cause of knee pain in young athletes

238
Q

What is the cause of osgood-schlatter

A

-overuse of the knee, repetitive stress on the patellar tendon by the quadricept muscle

239
Q

what is the presentation of osgood schlatters

A
  • tender, bony mass over the anterior tubercle
  • pain is worsened by some activities
  • pain is relieved by rest
240
Q

What is the treatment plan of osgood-schlatter

A

RICE

  • Ice 10-15 minutes 3x.day
  • avoid aggravating activities
  • play does not worsen activities
  • Quad strengthening
  • NSAIDs/Tylenol
241
Q

What is klinefelters syndrome

A

A condition in which males are born with an extra X chromosome

242
Q

What is the presentation of Klinefelter’s

A
  • testicles are small and firm
  • penis is small
  • tall stature
  • wider hips
  • reduced facial and body hair
  • high risk of osteoporosis
243
Q

What is the tx Klinefelters

A

-testosterone replacement and fertility treatment

244
Q

What is Turner’s syndrome

A

-females with complete or partial absence of the 2nd sex chromosome

245
Q

What is the presentation of Turner’s syndrome

A
  • congenital lymphedema of hands, feet
  • webbed neck
  • high-arched palate
  • short 4th metacarpal
  • short stature
  • ovarian failure
  • cardiovascular/renal issues
  • ear malformation
  • amenorrhea
246
Q

General precautions with any childhood vaccine

A
  • moderate or severe acute illness with or without fever

- especially fever >100.4

247
Q

Hepatitis A vaccine is universally recommended at ____ years and how many doses at what dosing interval

A
  • universally recommended for all children at age 1 year

- 2 doses should be 6 months apart

248
Q

What is the schedule for Hepatitis B vaccine

A

3 dose series at: 0, 1-2 months, 6 months after the first

-only immunization at birth

249
Q

Tdap starts at age

A
  • 7 years and up

- Get a booster at 11-12

250
Q

Live attenuated vaccines common side effects are

A
  • fever

- rash

251
Q

No live or attenudated vaccines before ____ years or age

A

1 year

252
Q

MC4 vaccine should be admistered

A
  • to all children ages 11-12 or 13-18 years if not previously vaccinated
  • Booster at age 16
253
Q

A common reaction with the HPV, MCV4 and Tdap is syncope this is an example of a:

a) localized reaction
b) systemic
c) allergic

A

b) Systemic

254
Q

Spacing of vaccines: A vaccine given ___ days prior to the scheduled time to receive is considered at valid dose

A

4 days

255
Q

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

A

-she is on tamiflu for flu prophylaxis

256
Q

what is CDC’s recommendation for length of time to monitor a child after immunization?

A

15 minutes

257
Q

A month reports that her 1 year old has an allergy to eggs that produces a non-pruritic rash. Which immunizations are contraindicated ?

A

none

258
Q

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

A

4 weeks; because if you don’t neither immunization will produce a protective titre

259
Q

ADHD DSM-5 criteria

A
  • 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
260
Q

What are the 2 notable exceptions to asthma management in children compared with adults

A
  • Use of LTRA (singulair)

- The way the drug is administered (neb or spacer)

261
Q

The most common pathogen for pneumonia in children 6 months to 5 years

A

Viral

262
Q

Immunization via PCV13 at 2,4,6 and 12-15 months helps prevent

A

Drug resistant strep pneumo

263
Q

Most sensitive sign of pneumonia in children is

A

-increased respiratory rate

264
Q

What is management of bacterial pneumonia in children

A
  • high dose amoxcillin 90g/kg/day

- If pen allergic: Macrolide/clindamycin

265
Q

What is the presentation of bronchiolitits

A
  • self limited
  • paroxysmal wheezing
  • increased respiratory rate
  • fever
  • cough
266
Q

What is the management of bronchiolitis

A
  • Self limiting, supportive care

- unless they have serious resp symptoms (ER)

267
Q

A 3 year old child presents with barky cough, no stridor and mild retractions how is this managed

A
  • single dose of oral dexamethasone (0.6mg/kg)

* has a long 1/2 life

268
Q

Welsey croup score criteria

A
  • retractions
  • stridor
  • cyanosis
  • LOC
  • air entry
269
Q

What sx might be present in the child who has suspected CF

A
  • recurrent pulmonary infections
  • weight loss
  • greasy stools
270
Q

What are symptoms of lead toxicity

A
  • fatigue
  • GI (constipation, stomach)
  • irritability
271
Q

What are the most common presenting signs of leukemia

A
  • fever (evening)
  • bleeding
  • bone pain
  • lymphadenopathy
  • fatigue
272
Q

Rule about nodes

A

> 10mm is enlarged

Exception:

  • epitrochlear enlarged if >5mm
  • inguinal enlarged if >15mm
  • Cervical enlarged if >20mm
273
Q

How do you manage encopresis

A
  • 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

274
Q

Viral Gasto rehydration

A

50-100ml/kg over 4 hours

*Pale yellow urine signifies hydration

275
Q

Heart rate and dehydration

A

Mild- normal
Moderate- rapid
severe - rapid and weak

276
Q

When should a patient with cryptorchidism be referred to urology

A

6 months of age

277
Q

A 9 month old has a hydrocele what advise should you give to a caregiver?

A

-it should resolve by 9 months

278
Q

What is the most common cause of a persistent hydrocele?

A

-hernia

279
Q

What is the most common cause of pediatric UTIs

A

-vesicourethral reflux

280
Q

UTIs are aggressively treated in infants to prevent

A
  • pyelonephritis
  • renal scarring
  • hypertension
  • end-stage renal dysfunction
281
Q

How do you manage pediatric UTIs

A
  • treat empircally
  • get a urine C&S
  • Give 3rd general cephalosporin x 3-5 days if afebrile; 10 days if febrile
282
Q

Imaging for pediatric UTI

A
  • renal and bladder ultrasound for all infants 2-24 months

- voiding cystourethrogram test of choice for vesicourethral reflux

283
Q

What is kawasaki’s disease

A

acute generalized systemic vasculitis of the medium-sized vessels

284
Q

What dx should you order for kawasaki

A
  • CBC
  • ESR
  • CRP
  • ALT/AST
  • Echo
285
Q

What are the characteristics of innocent murmurs

A
  • grade 2 or less
  • soft
  • not holosystolic
  • minimal radiation
  • musical/vibratory
  • movement makes it go away
  • child is on their growth chart
286
Q

Nursemaid’s elbow is the result of a

A

pull injury; annual ligament slips over the head of the radius and becomes trapped

287
Q

What term describes the pain in osgood schlatters

A

-osteochondritis

288
Q

At what age does osgood schlatters disease most often occur

A

9-14

-often after a big growth spurt

289
Q

Pain with osgood schlatter can last

A

6-18 months

290
Q

The management of osgood schlatter

A
  • continuation of activity as pain tolerates
  • ice
  • analgesics as needed
291
Q

What is Legg-calve-perthes disease

A

Osteonecrosis of the capital femoral epiphysis due to interrupted vascular supply

292
Q

How does legg-calve-perthes present

A
  • pain to hip or referral to medial aspect of the knee
  • limp
  • pre pubescent children
293
Q

What exam will you do for evaluating hip abnormalities

A

Trendelenburg

294
Q

What is a positive trendelenburg

A

-asking child to stand on affected side causes a pelvic tilt

295
Q

When is trendelenburg positive

A

-SCFE, legg-calve perthes disease and developmental dysplasia of the hip

296
Q

What imaging should you get in hip pain

A

-AP and frog-leg

297
Q

What is the presentation slipped capital femoral epiphysis

A
  • hx of several week or months of hip/knee pain with limp
  • in adolescents
    • trendlenburg
298
Q

Transient synovitis of the hip

A

benign condition causing acute limp and hip pain in children

  • will have had an URTI in 7-14 prior
  • negative trendelenburg
299
Q

This maculopapular brick red rash starts on the head and neck and spread through trunk and extremities

A

Measles (Rubeola)

300
Q

This illness causes a slapped cheek, lacy, macular rash

A

Fifths disease; erythema infectiosum

301
Q

High fever for 2-4 days then abrupt cessation of fever with appearance of maculopapular rash but not on face

A

roseola

302
Q

For all viral exanthums except chickenpox when can kids return to school or daycare

A

-24 hours after afebrile

303
Q

Exotoxin rash secondary to group A strep infection, sandpaper like rash that desquamates

A

Scarlet fever

304
Q

What is the presentation of mealses

A
  • Koplik spots
  • Fever
  • Malaise
  • 3 C’s (conjunctivitis, coryza and cough)

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