Peds Flashcards

1
Q

Define the two parts of the prenatal period

When do the most critical stages of development occur

What are TORCH infections

A

Embryonic: through 8wks EGA
Fetal: 9wks EGA +

First trimester

Toxoplasmosis Rubella CMV HSV

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2
Q

Rh incompatibility can lead to ? OB complication

Define APGAR

Why are the timings of this score different

A

Hydrops fetalis

Appearance Pulse Grimace Activity Respiration:
0-10pts w/ 5 features, done at 1min and 5min-
Rpt q5min if score <8

1min: tolerance of birthing process
5min: tolerance to life

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3
Q

What are the APGAR scores made

A

Appearance:
0- cyanotic 1- Acrocyanosis/blue extremities 2- all pink

Pulse:
0- none 1- <100bpm 2- >100bpm

Grimace w/ bulb suction to nares:
0- none 1- grimace/cry w/ stimulation 2- sneeze/cough/withdrawal w/ stimulation

Activity:
0- limp/none 1- some flexion 2- active

Respiration:
0- none 1- weak/slow/irregular 2- strong cry

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4
Q

Newborn respiratory rate

Newborn HR

What are the next steps taken for abnormal HR ranges

A

30-60/min w/ inc number if premature

120-160

> 100: routine care
60-99: ventilation support
<60: ventilation w/ compressions

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5
Q

Neonatal Resuscitation Protocol flow chart

A

Compressions at 120bpm w/ two thumbs > two fingers
3 compression : 1 respiration

BVM sniffing position (neck w/ slight extension) w/ 40-60 bpm

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6
Q

How do premature/neonates respond to hypoxia

What fluids are used during NRP

What is the next step for asystole/bradycardia unresponsive to O2

A

Apnea rather than tachypnea

10mL/kg NS for hypo-volemia/tension

IV Epinephrine

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7
Q

Rules for Narcan usage in newborns

? care is routine for all infants and w/ ? goal

What are the two categories of this care and what is done during each

A

Yes- opiates used during labor
No- maternal addict/methadone d/t withdrawal seizures

Nursing- prevent illness/complications w/ high level of morbidity/mortality

A) Shortly after:
Erythromycin ointment- prevent G/C conjunctivitis
Vit K injection- prevents Hemorrhagic Dz of Newborn
HBV- only vaccine given at birth

B) 24hr Routine Care:
Bilirubin screen
Congenital heart screening
Genetic/Metabolic screen (AKA- newborn screen)
Hearing
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8
Q

Infants receive Vit K injections into their thigh at birth to prevent HDzoN which is more common in ? population and will present as ?

? genetic/metabolic tests are included in the Newborn Screen

Infant length is done in ? position until ? time frame and when are inaccurate measurements most likely to occur

A

MC in breast fed infants in first few weeks of life;
Generalized ecchymosis
GI bleeds
Umbilical/Circumcision bleeding

CF CAH PKU Sickle TSH

Laying down until 2yrs old;
First week d/t positioning

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9
Q

Congenital heart dz screening is done at 24hrs of life/before d/c and is interpreted how

A

Spo2 95% or higher w/ 3% or less difference between right hand/foot= negative screening, plan for d/c

SpO2 90-94% in right hand/foot or 3% difference= repeat in one hour; same results- repeat again in one hour; 3 readings in same range= echo

SpO2 <90% in right hand/foot= +screen- order Echo

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10
Q

? is the number one cause of LBW

Criteria for Low/Very Low birth weights

What are the RFs for LBW

A

Prematurity

Low: <2500gm; Very: <1500gm

Previous LBW baby
Age <16, >35
Socioeconomic status
Tobacco/ETOH/Drugs
Poor weight gain during pregnancy
Education
Antenatal care
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11
Q

Normal sutures and two abnormal findings possibly seen in newborn HEENT exam

Define Caput Seccedaneum

Define Cephalohematoma

A

Normal: open/flat sutures
Anterior suture >5cm suggests hypothyroidism
Closed sutures: craniosynostosis

Boggy, edematous swelling crossing lines, self resolves

RBC breakdown/jaundice causing swelling w/out crossing suture lines

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12
Q

? head malformation is associated w/ vacuum deliveries and how is it Tx

Define Hydrocephalus, the two types, and Tx

A

Subgleal hemorrhage- swelling crosses suture lines pushing ears anteriorly;
Tx: Compression w/ resuscitation PRN

Inc CSF volume- macrocephaly, bulging fontanelle, ‘setting sun’ gaze;
Communicating w/ subarachnoid
Non-Communicating= obstructed
Tx: ventriculoperitoneal shunt

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13
Q

What can cause an abnormal red reflex on newborn eye exam

What optic abnormality can be normal until 4mon old

How is normal ear positioning verified

A

Leukocoria: cataract, tumor, retinopathy of prematurity

Disconjugate gaze: eyes fail to move in same direction; alignment achieved at 4mon old

1/3 of ear above canthus/occipital protuberance line
20* from anterior of lobe to superior helix

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14
Q

Define Epstein Pearls and Bohn Nodules

What parent education goes w/ Dx

When conducting new born exams, how do neck bulge locations hint at Dx

A

EP: Keratin cysts on gums/palate
BN: Keratin cysts on salivary tissues

Harmless, resolve in first week of life

Anterior midline: thyroid d/o
Anterior to SCM: brachial cleft cyst
Posterior to SCM: cystic hygroma

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15
Q

What do each of the following suggest for cardiac d/o/dz

Weak pulse

Bounding pulse

Single second sound

Holosystolic, continuous, harsh

Grade 3/>

Diastolic murmur

Hempatomegaly

A

Weak: poor CO/AS

Bounding: high CO, PDA

Second sound: cyanotic dz- truncus/hypoplastic heart

Holosystolic, continuous, harsh- pathologic

Grade 3/>: pathologic

Diastolic: pathologic

Hempatomegaly: left sided HF

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16
Q

How are lower extremity pulses assessed during newborn exam

? abdomen shape suggests diaphragmatic hernia

? umbilical finding suggests need for detailed exam

A

Brachial and femoral together:
Pulse pressure >40mm= r/o PDA
LE < UE pulse= r/o coarctation

Scaphoid

Two vessels: 1 artery, 1 vein instead of normal 2A/1V

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17
Q

Umbilical cord stump remaining longer than ? needs further work up

? DDxs need to be r/o

A

1mon

Umbilical polp: sticky surface
Patent Urachas: urinary d/c
Meckels: proximal end of vitelline duct
Vitelline duct: odorous d/c

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18
Q

What is the main concern w/ hip exam

Since all infants are born w/ limited laxity, what are the three concerns if this persists

RFs for Congenital Hip Dysplasia

A

Congenital Hip Dysplasia- spontaneous dislocation and reduction of femoral heads; L > R

Flat acetabulum
Muscle contraction limiting ROM
Capsule tightening

Female First FamHx
Breech
Oligohydramnios
Postnatal swaddling position

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19
Q

What are the two maneuvers done for hip stability during newborn exam

If ‘clunk’ is heard, ? is the next step

What populations should received this next step

A

Barlow
Ortolani- clunk from hip relocating anteriorly

Hip US at 4-6wks to avoid confusion w/ normal laxity

Clunk or persistant click x 2wks of age
+ RFs- US after 4-6wks old

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20
Q

Congenital Hip Dysplasia referred to Peds Ortho will be placed in ? device for ? age groups

? is the MC foot d/o in infants

Infants w/ this MC are at risk for developing ? later in life

A

Pavlik harness- up to 6mon old

Metatarsus adductus- medial deviation of mid and forefoot

Developmental hip dysplasia

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21
Q

How is Metatarsus Adductus Dx

How are these Tx

Define Talipes Equinovarus

What is the next step after Dx Talipes Equinovarus

A

Mid-heel bisector line- should go between toes 2-3
V-finger- should not gap at base of 5th MT (styloid)

Most self-resolve
If not w/in 2yrs= Ortho referral cast/brace/surgery

Clubfoot- entire leg involved d/t hypoplastic tarsals and limb muscles
MC affected- talus, causes foot shortening/calf atrophy

Refer to Ortho: casting/tenotomy to correct deformity, preserve mobility

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22
Q

? testi/female genitalia abnormalities can be seen on newborn exam

Define Spina Bifida

When/How is this normally identified during pregnancy

A

Testi: retractile
Female: hypertrophy d/t maternal estrogen

Cleft Spine; Lumbosacral tube defect d/t incomplete brain/cord/meninge development

2nd-Tri Quad screen- maternal A-fetoprotein/US

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23
Q

Define Rachischisis and ? risk needs to be r/o

A

Spina Bifida Occulta- hair tuft/minor defect w/out neuro S/Sxs; r/o connecting sinus d/t inc risk for meningitis

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24
Q

What are the categories of Spina Bifida

How is this Tx and avoided

A

Meningocele- meninges herniates through neural arch

Meningomyelocele- meninges and cord herniate through neural arch

Myeloschisis- open skin w/ cord exposed

Neurosurgery;
Folate prior to tube closure at 4-6wks EGA

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25
What are the primitive reflexes tested for on newborn exam What do these reflexes evaluate When do these normally disappear What could cause an asymmetric/persistent response
Suck Moro Grasp Brain stem, Basal ganglia 4-6mon d/t increased cerebral inhibition of Focal brain/peripheral nerve lesion
26
Only reflex not present at birth and never disappears What reflexes disappear at 3, 4, 6 or 12mon
Parachute- appears at 8-10mon; suspended face down, move towards table causes arm extension for protection 3: Asymmetric tonic neck 4: Rooting, Gallant, Placing 6: Moro, Grasp 12: Babinski
27
Facial palsy in newborn is associated w/ ? Define the MC brachial plexus lesion What reflex is present/absent in this MC
Forcep delivery Erb-Duchenne palsy- C5/6 lesion, association w/ phrenic nerve lesion d/t shoulder dystocia + grasp - bicep
28
# Define Klumpke Palsy What syndrome is this associated w/ if a cervical sympathetic nerve root was injured Define Vernix Caseosa
C8-T1 lesion: - grasp +bicep w/ claw hand Ipsilateral Horner's Syndrome Chalky white mixture of shed epithelials cells, sebum, keratin and hair; common in preterms for suspected fetal protection
29
When is term infant desquamation typically seen Define Milia Define Milia Rubra
24-48hrs of life Smooth, white papules on face/scalp d/t trapped keratin; self limited/resolves 1-4wks Heat rash d/t overheated/febrile infant w/ erythematous papules; Tx/correct overheating
30
# Define Cutis Marmorata Define Slate Gray Nevi Define Cafe Au Lait macules and when are further work ups indicated
Mottling- cold response; persistent suggests hypothyroidism/vascular malformation Transient dark macule on lower back/buttocks that fade w/ time Sharply defined, pigmented macules; 6 or more/ 5cm or bigger to r/o NF-1, TB, McCune Albright Syndrome
31
Nevus Simplexes are AKA ? Define Nevus Flameus ? syndrome needs to be r/o depending on location
Salmon patches Stork bite- nape of neck Angel kiss- forehead/eyelids Port Wine Stain; d/t capillary bed malformation Sturge Weber Syndrome if trigeminal nerve distribution
32
# Define Erythema Toxicum Neonatorum Wat would be seen on microscopy results What causes neonatal acne
Pustules w/ erythematous base on back/trunk appearing 1-2 days after birth, resolves in 14days Eosinophils Maternal estrogen
33
Primitive reflexes are usually gone by ? age RFs for neonatal sepsis
4-6mon ``` Prematurity PROM Fetal tachy Amnionitis Maternal fever GBS ```
34
Neonatal sepsis etiologies w/ early onsets Neonatal sepsis etiologies w/ late onsets
``` Mycoplasma GBS- MC/#1 E coli Klebsiella Listeria Salmonella ``` ``` Hflu Neisseria meningitidis CMV HSV Enterovirus Strep pneumo Staph ```
35
Early onset neonatal sepsis begins on ? day and presents w/ ? Late onset neonatal sepsis begins on ? day and is more likely associated w/ ? What orders are needed
0-7d old; Fast onset, Hypo-thermia/tone/tension 8-28d old; Insidious onset, Dec feeding/tone, Bulging fontanelle; associated w/ meningitis ``` CBC CXR if + resp Sxs Blood culture x2 UA w/ culture Blood glucose LP ```
36
How is Neonatal Sepsis Tx Why would Vanc be added to Tx regiment Three steps for GBS mother
Draw labs then: IV Ampicillin+Gentamicin IV Amp+Cefotaxime if >3wks d/t liver function Late onset, + meningitis, MRSA coverage 1: infant have S/Sxs? Yes: eval w/ empiric Tx No: step 2 2: infant <35wks EGS? yes; limited eval w/ 48hr observation no: step 3 3: Two maternal ABX doses prior to delivery? Yes: no eval/therapy, observe x48hrs No: limited eval w/ 48hr observation
37
? PE finding is a sign of neonatal respiratory distress What Dzs make this finding MC found Respiratory Distress Syndrome is AKA ? and caused by ?
Grunting (can sound like meowing) Dec functional residual capacity: Pneumonia Pulmonary edema Peripheral airway obstruction Hyaline Membrane Dz: dec surfactant from Type 2 pneumatocytes in <34wks EGA
38
RDS results in ? and looks like ? on CXR How is RDS Tx prior to birth How is RDS Tx after birth
End expiration atelectasis; Ground glass Maternal steroids 32-34wks EGA Intubation w/ surfactant/support via ET tube
39
What complications can arise from RDS Which one appears on day 2-4 of life and what does this look like How is this Tx
PDA PTX Bronchopulmonary dysplasia Retinopathy of prematurity PDA: L to R shunt (systemic to pulm) as pulmonary edema/hepatomegaly Fluid restriction w/ diuretic Indomethacin/Ibuprofen
40
How is RDS induced PTX Tx What causes the Bronchopulmonary Dysplasia after RDS What are the 3 RFs for this dysplasia
Sxs= chest tube O2 toxicity/barotrauma O2 dependence at 36wks old RDS persists >14days Prolong mechanical ventilation
41
How does RDS cause Retinopathy of Prematurity Criteria for Apnea of Prematurity What are the two types and causes
O2 toxicity causes vasoconstriction in developing vessels= obliteration/blindness (term infant eyes fully vascularized- no risk) 10-20sec w/out pulmonary airflow Central: medulla/pons don't stimulate phrenic nerve (more common in premature infants) Obstructive: malformation/positional
42
How is Apnea of Prematurity Tx When does this usually correct itself by? ? is the MC congenital tracheal abnormality
O2, Stimulants: caffeine/theophylline 36-40wks post-conceptual age Tracheomalacia- weak/floppy tracheal wall worse during expiration (harsh, monophonic wheeze/normal voice/inspiration)
43
Four possible outcomes from Meconium Aspiration Syndrome How are non-vigorous babies w/ aspiration managed How does aspiration appear on CXRs
Respiratory distress Pneumo-nia/nitis/thorax Suction mouth/trachia Unsuccessful: BVM w/ PPV Coarse, irregular infiltrates
44
What causes Transient Tachypnea of the Newborn How would this appear on CXR When is this type of issue more commonly seen
Retained amniotic fluid causes hypoxia that resolves <24hrs Fluid in fissures C-section, LGA d/t no 'squeeze' during birth
45
How does P-HTN in term infant present MCC of Hemolytic Dz of newborn What are the three reasons all newborn have an elevated bili
Primary: Hypoxia w/out cardiac/pulm dz and normal CXR Non-Primary: induced L to R shunt ABO incompatibility Inc RBC turnover Dec hepatic clearance/gut motility
46
Neontal hyperbilirubinemia is ? levels ? is the MCC of neonatal jaundice Define Kernicterus
Total Bili >5mg/dL Hemolytic Dz of the newborn- ABO incompatability is MCC Bilirubin Encephalopathy- indirect bili deposits in brain, disrupts neuron metabolism/function
47
Early signs of Kernicterus Late signs of Kernicterus
``` Day 4 of life w/: Lethargy Emesis Hypotonia High pitch cry Irritable Poor Moro/feeding ``` ``` Fever Hypertone Bulging fontanelle Opisthotonic posture Pulmonary hemorrhage Paralysis of upward gaze Seizures ```
48
What are the two classifications of hyperbilirubinemia What is a common cause of jaundice in first time mothers What causes Adequate Intake Breast Milk Jaundice
Unconjugated: estimated w/ indirect (MC) Conjugated: direct; rare but more serious Breastfeeding jaundice- lack of adequate feeds causes dec gut motility on day 2-3 of life Defected milk w/ conjugation inhibitor, increased hepatic recirculation d/t glucuronidase; seen on day 7-10 w/ bili rarely above 20mg
49
What is seen on lab results to aid w/ Dx of Breast milk Jaundice Jaundice seen at ? point in time is always pathologic Un/Conjugated DDxs
Unconjugated hyperbilirubinemia w/out hemolysis 1st day of life Indirect: Hemolysis, Insufficient conjugation Direct: Biliary atresia, Unresponsive to phototherapy or transfusions
50
Characteristic clues of Physiological Jaundice Characteristic clues of Pathological Jaundice When evaluating jaundice, ? is the first location that needs to be assessed
Evidence starts w/ bili at 5-6 or, Preterm w/ bili <15 on day 5 of life: Yellow skin started on face, moves down ``` Very early, very fast: Peak bili w/in 24hrs of life in term infant Bili rises 0.5/hr or 5mg/dl/day Jaundice w/in 24hrs of life Hepatosplenomegaly and anemia ``` Under tongue THEN sclera
51
? is first line test ordered for evaluation of neonatal jaundice How are these Tx if Mild, Mod or Severe What are the short and long term adverse effects of neonatal phototherapy
Transcutaneous then serum bili Mild: lifestyle, breast feed, sunlight Mod: phototherapy Sev: exchange transfusion if levels >20 Short: Diarrhea, Dec bonding, GI hypermotility Temp instability Long: Inc risk for asthma and DMT1
52
What is included in a standard well visit Define Neonate Define Infant
Growth Development Imms Guidance Screenings 0-28d old 29d-1y/o
53
# Define Toddler Define Pre-Schooler Define Child
1-3y/o 2-5y/o 1-12y/o
54
# Define Adolescent Define Growth Define Development
13-18y/o Increase in body size Increase in function/process
55
Developmental Scales are AKA ? and use ? as more more detailed screening Define Developmental Milestones What is the MCC of abnormal growth chart results
Ages and Stages; Denver Developmental Screening Test 2 Observable traits/actions that present/fade at predictable ages Operator error
56
Weight loss expected during first few days of life Time frame to return to birth weight, double and triple their weight What is considered normal daily weight gain
5-10% of birth weight Return by day 14 Double 4-5mon Tripled birth weight by 12mon 20-30g x first 3-4mon 15-20g x remainder of first year
57
Average length at birth is ? By 4y/o, average child length has increased by ? much Average head circumference at birth is ? and increases by ? much
20" at birth 30" at first year Double birth length or, 40" 35cm at birth Inc 1cm/mon x first 12mon (2cm/mon first 3mon)
58
How long are head circumferences taken at child appointments Pediatric weight percentiles/categories How are heights predicted for fe/males
Until 2y/o <5th: underweight 5-85th: normal 85-95th: over weight >95th: obese M: Paternal + Maternal/2 + 2.5 W: Paternal + Maternal/2 - 2.5
59
What is the 2 Year x 2 Method for predicting height What is the most accurate method for predicting height MC factor affecting growth
Height inches at 2y/o x 2 Bone age w/ hand x-ray Hereditary factors
60
Babies born small/premature can be expected to go through 'catch up' growth during ? frame When is medical interventions indicated for deficient growth patterns When is it normal to see a decline in growth rate
First 6mon <5% w/out cause Crosses two percentile lines w/out cause Discrepancy between Circumference/Weight/Length After 2y/o
61
Nutrition/growth during ? pat of life predict adult stature and health outcomes When is the biggest risk for stunted growth It is recommended breast milk as sole nutrition source for premature infants d/t ? benefits
First 3yrs 4-24mon 6mon; Lower readmission rates Long term IQ development
62
What can be used for Vit D/Fe supplementation for breast feeding mothers Absolute c/is to breast feeding Mothers should limit alcohol consumption to ? much
Polyvisol ``` HIV Active TB Varicella H1N1 HSV on breast ``` <0.5mg/kg
63
What are the three categories of formula
Cow milk based: Fortified w/ Fe, no sterilization needed Soy based: Lactose free alternative w/ possible isoflavone effect Casein hydrolysate: Used when absorption/digestion problem exists, $$
64
Do not feed infants honey/canned goods until ? age Begin solid foods at ? age Avoid cows milk until ? age Avoid whole milk until ? age
12mon 6mon 12mon d/t risk for GI bleed/anemia 24mon
65
Do not substitute formula w/ soy milk for infants under ? age d/t ? risks Toddlers 1-12y/o need to avoid ingesting more than ? muck cows milk/day Over weight children don't need to be on diets before ? age
<12mon; Scurvy Anemia Malnutrition >24oz 3y/o
66
What age groups should WHO growth charts be used ? age should CDC growth charts be used When/How is autism screened for
Birth - 2y/o 2y/o - 20y/o M-CHAT-R at 18, 24mon >2 predictive or >3 total behavior= further work up
67
What is the ASQ How is it adjusted for pre-mature born infatns What 5 areas are surveyed
21 age specific surveys about developmental skills 3wks premature for up to 2y/o Problem solving Communication Motor Personal/Social
68
What are the red flags for Gross Motor What are the red flags for Language
Rolling <3mon old= inc tone Poor head control at 5mon= dec tone Lack of sitting at 7mon= dec tone Hand dominance <18mon= contralateral motor abnormality ``` Vary pitch by 4mon Lack of babble by 6mon No word/gesture by 15mon No pointing by 18mon Less than 50% intelligible speech at 24mon ```
69
All children w/ speech delay need ? tests When do Well Child Exams take place BP is not a standard part of VS until ? age and how is it calculated
Ear exam Hearing eval w/ tympanometry and audiometry Auditory Brain Stem Response- r/o peripheral loss Day 3-5 Week 2 Mon 2 4 6 9 12 15 18 24 30, then annual After 3y/o SBP= 80 + Age x 2 DBP= 2/3 of SBP
70
How is newborn metabolic screening conducted ? metabolic issue is screened for at every visit Guidelines for newborn exams when 0-6mon, 6-36mon and >36mon old
Hgb electrophresis Obesity 0-6: no fear, easily comforted/distracted 6-36: fear of stranger/doctor, harder to restrain; moody >36mon: less fear, more interaction
71
When are anemia screenings conducted How much lead accumulation can cause irreversible developmental/behavior abnormalities When does cholesterol screening begin
12mon if healthy 4mon if high risk 5-10ug/dL; screen at 12mon Non fasting 9-11y/o and 17-21y/o Overweight/Obese- fasting Parent cholesterol >240= high risk, start at 2y/o
72
What are the accepted cholesterol limits in kids ? populations are considered high risk for TB and when do screenings begin
Borderline: <170 High: >200 Acceptable LDL: <110; Border: 110-129; High: >130 HDL should be >40 12mon/>: Close contact; w/ high risk adults Health care workers Foreign born in high TB areas
73
# Define Active Immunity Define Passive Immunity Define Primary Prophylaxis Define Secondary Prophylaxis
Immunity from vaccine/toxoid Maternal Ab transfer/administration of Abs Prevent infection before first occurrence Prevent recurrence after first infective episode
74
How are premature infants immunized What is the exception to this schedule When is DTaP given
Regardless of birth weight, same chronological age/schedule Hep B vaccine if <2000g w/ HBsAg negative mother- give first dose at 1mon 5 doses at 2, 4, 6, 15, 48mon One adult dose at 12
75
When is Hep B vaccine given Why his HIB vaccine given When is MCV4 Meningococcal given
First of three at <24hrs old if healthy term Protection from meningitis/epiglottitis 11-12y/o or prior to college
76
When is Hep A given When can influenza be given Prevnar vaccine is given to protect from ?
Two doses: 1-2y/o 6mon Pneumococcal
77
When is HPV vaccine given Describe the Rotavirus vaccine and when it's given How long should rear facing car seats be used and how long should kids ride in back seat
Early as 9 Target of 11 Two doses if completed by 15y/o Live attenuated cow virus; First dose- 15wks old, final dose NLT 8mon 2y/o; Back seat until 13y/o
78
Risks of tobacco smoke Sequence of teeth eruptions at ? ages What labs are ordered if delayed tooth eruption is present
LBW SIDS Respiratory illness- asthma Otitis media Deciduous: lower central incisors to upper central incisors to lateral incisors; Permanent 6-12y/o w/ 3rd molars by 18y/o TSH, Ca for Hypothyroid/Hypopituitary, Rickets
79
Sequence of deciduous teeth eruptions Sequence of permanent teeth eruprtions
``` Lower central incisor Upper central incisor Lower lateral incisor Upper lateral incisor Lower first molar Upper first molar Lower second molar Upper second molar ``` ``` L central incisor First molars U central incisor L lateral incisor U lateral incisor L cuspid U cuspid U second cuspid L second cuspid L second molars U second molars Third molars ```
80
Avoid fluoride tooth past until ? When do dental visits/cleanings begin What is the ultimate goal of discipline
24mon 12mon w/ cleanings q6mon Child's self control
81
# Define SIDS What stats belong to this Dx of exclusion What therapy may be beneficial in prevention during the first year
Unexpected death <1y/o unexplained by autopsy/CSI and review of clinical history Third leading cause of US infant mortality MCC of death 1mon-12mon old Pacifiers
82
What is the risk of Back-To-Sleep position When does this Dx require no further eval When is further eval warranted
Pagiocephaly Normal then Dx develops w/ improvement in 2-3mon No improvement in 4-6mons- craniofacial specialist
83
Gross Motor Skills at 4mon old Gross Motor Skills at 9mon old Minimum age for child to be forward facing in car seat
Rolls front to back, no head lag w/ pull from supine Pulls to stand, gets into seated position 2y/o that outgrew rear facing weight/height limits
84
Criteria for FTT Dx What are the three classifications of FTT What are the two patterns and their meaning
Weight <3rd percentile Weight decreases by two major percentile lines Weight <80% of median weight for heigt Type 1: Wasting; deficient weight gain d/t malnutrition Type 2: Shunting; deficient linear growth w/ head circumference spared d/t malnutrition x months Type 3: Symmetric; proportional loss weight, height and circumference d/t long standing malnutrition, chromosome abnormalities or infection/exposures Dec weight after certain age: infection, endocrine, environment Body asymmetry: epiphyseal, chromosomal
85
Basically FTT is d/t ? and 1/3 of organic causes are ? How is FTT corrected Why is Refeeding Syndrome deadly
Insufficient nutrition at cellular level; GI causes Inc calories/protein <>1.5x During starvation- dec metabolism to force storage for homeostasis Rapid feeding- loss of fluid/E+; fluid retention, Hypo-Phos/Mg/K/Ca
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Autosomal dominant congenital malformations Autosomal recessive congenital malformations X-linked congenital malformations
``` Achondroplasia Neurofibromatosis Huntingtons Marfans Polycystic kidney ``` CF PKU CAH SS ``` Fragile X- excessive gene base repeats Muscular dystrophy Hemophilia A G6PD deficiency Color blindness ```
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RFs for Downs Syndrome What do all Pts w/ Downs need to have ordered What are the three forms of Trisomy 21
Inc maternal age, Parental genetics Chromsomal analysis, + translocation= parental analysis MC- maternal non-disjunction Translocation- part of #21 is stuck on another chromosome prior to replication Mosaicism- rarest; pehnotypical normal Pt
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What will be seen on PE of Down Syndrome What are the face characteristics What are the extremity characteristics
Generalized hypotonia- dec Moro reflex Small head ``` Flat bridge d/t midface hypoplasia Up slanting fissures Macroglossia Epicanthal folds Dysplastic pinna ``` Single palmar crease Shortened mid-5th phalanx Wide first toe interspace
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All Down Syndrome Pts will have ?, two-thirds have ? and half will have ? What type of hearing loss will majority have What eye defects will they have
All- developmental delay 2/3: polycythemia Half- cardiac anomalies SNHL ``` Cataracts Refractive error Ectopic lens Brushfield spots Strabismus ```
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? x-ray finding in Down Syndrome needs immediate surgical Tx What is the routine health care check list for all Down Syndrome Pts
Duodenal atresia; seen as "double-bubble" sign Hearing screening q3mon until 3y/o, then annual Cards for Echo Optho by 6mon then annual Annual TSH/CBC, Celiac screen
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? is the most preventable cause of developmental delay/intellectual disability What are the classic facial features What hand feature is seen
Fetal Alcohol Spectrum D/o Short palpebral fissures Smooth philtrum Thin upper lip Clinodactyly- hockey stick crease
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What developmental abnormalities are seen in FASD How much ingestion puts fetus at risk for developing this What multidisciplinary team is assigned to these Pts
Fine motor delay ADHD Retardation >7/wk or >3 drinks per period ADHD Anxiety therapy Speech SpEd
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Developmental/Neuro problems seen win Fragile X Syndrome What physical attributes will be seen How is this definitively Dx
Hyperarousal Anxiety Mood lability Epilepsy Sterotypy Joint laxity Oblong face Hypotonia Macro-orchidism DNA amplification w/ direct analysis
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# Define 45XO Majority of defects arise from ? side What may be seen shortly after birth if infant survives to delivery
Turner Syndrome d/t no/abnormal X 2/3 of X are maternal Extremity edema
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What type of mental development is seen w/ Turner Syndrome What CV issues are usually seen What endocrine d/os are seen
Poor visual-spacial skills Superior verbal skills Coarctation Early onset HTN Bicuspid aorta Hypothyroidism Osteoporosis DMT1
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How is Turner's Dx What Dx method is not recommended How are these Pts Tx/managed
Direct karytotyping Barr body analysis Annual TSH, Chem-7, UA Cards- Echo, MRI, EKG Endo- GH initiation
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# Define Klinefelter Syndrome What issue can present How is this screened, Dx and what would be seen on lab results How are these Pts Tx and what are they at risk for
47XXY: phenotypically normal prior to puberty Result of testosterone deficiency: Irregular features Violent tendencies Severe MR Screen: Barr body Dx: direct karytopying Inc LH/FSH w/ low T T replacement 16-30x inc risk for breast Ca
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What type of genetic defect leads to Marfans What three systems are affected Crying from an infant can signal ? possible issues
Fibrillin 1 gene on Chrom #15 Ortho: arachnodactyly CV: AV insufficiency/dissection Ocular: dislocation Pain Distress Fatigue Hunger Pain > Hunger= higher pitch/intensity
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What is the correlation to crying if infant is preterm When is the diurnal variation more common How loud can these reach
Little before 40wks old More than term infant at corrected 6wks Late afternoon/evening 80dB
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What findings suggest a crying infant has colic What is the Wessel's Rule of 3 for Colic When does the Dx of exclusion begin to risk maternal health
Paroxysmal crying w/ grimace, leg flexion and flatus ``` Starting at 3wks: Crying >3hrs/day Crying 3d/wk Crying longer than 3wks Resolves around 3mon old ``` Inc PPD risk if crying episodes >20min
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? is the MC reported behavior problem in kids 2-3y/o When does this MC become an abnormal How can these be prevented
Temper tantrum ``` Past 4y/o Injury to self/others Lasting >15min >5/day Negative mood swings w/ tantrum ``` Parental education at 12-18mon
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# Define Intellectual Disability What type of testing results aids w/ Dx DSM-5 requires impaired behavior across ? areas
D/o w/ common deficits of adaptive/intellectual function and an onset before maturity is reached <2SD, IQ <70 Practical/conceptual/social behavior
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# Define Global Developmental Delay Possible environmental RFs for Autism What screening form is used for this Dx and when
Children <5y/o w/ >2SD delay in multiple milestones ``` Infections- Rubella, CMV Maternal obesity Advanced parent age Premature Short interval from prior pregnancy ``` M-CHAT-R at 18-24mon Two predictive- hearing concern, finger movement near eye, noise sensitivity or, Three total
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# Define Cerebral Palsy What are 3 potential RFs Two PE findings suggestive of Dx
Non-progressive motor impairment syndromes; static encephalopathy Intrauterine infection Multiple pregnancies Infertility Tx Athetosis, Chorea
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What are the 6 classifications of Cerebral Palsy
Mixed- catch all for Pts that don't fit other patterns Ataxic- cerebellar injury causing abnormal posture/coordination Dyskinetic- involuntary, repetitive movements Dystonic- rare; stiff/dec movements Spastic- MAJORITY; pyramidal tract injury to upper neurons w/ two: abnormal movement, inc tone, pathologic reflexes Choreoathetotic- hyperkinesia, hypotonia; rare now that bilirubin is Tx
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How is ADHD Dx if Pt is 16y/o or < How is ADHD Dx if PT is 17y/o or older What genetic d/os are associated w/ this condition
16y/o or : 5 Sxs of inattention or hyperactive impulsitivity x 6mon in two environments Fragile X 22a11.2 deletion syndrome NF-1
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What is at the core of all ADHD Tx What meds are used first line What SNRI can be used What A-agonists can be used
Behavior management Methylphenidate Amphetamine Atomoxetine Clinidine, Guanfacine
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# Define Oppositional Defiant D/o Define Conduct D/o What screening tool is used for OCD
Moody, defiant, vindictive behavior Pattern of behavior where basic rights/norms are violated: Aggression Destruction Deceit Violation Vanderbilt
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What is the mnemonic for interviewing adolescent Pts
``` HEADDSS: Home/Friends Education Alcohol Drugs Diet Sex Suicide/Depression ```
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Average age for female puberty is ? but preccocious puberty is defined as ? Tanner stages associated w/ TAPuPMe Completion of Tanner stages takes ? amount of time for male and female
11y/o; 6y/o in AfAm; 7 y/o in Caucasian Thelarche: Tanner 2 Ad/Pub: Tanner 2 Peak: one year after thelarche, tanner 3-4 Female: 4-5yrs Male: 2.5-5yrs
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Once female starts menarche, ? much expected height growth is expected remaining Tanner Stages Mnemonics from OBGYN Sexual Maturity Rating for female for pubic hair/breast
2-5cm Deck 1: preadolescent/preadolescent 2: sparse/elevations 3: darker curls/enlargement w/out contour separation 4: abundant and coarse/secondary mound 5: adult triangle/adult contours
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When do boys going through puberty pass through Tanner 1 to 2 How does onset of adrenarche present Both male and female Pts going through puberty will have ? elevated lab result and ? previous issue may worsen
9-11y/o Pubic, axillary <12mon later inc ALP d/t rapid bone turnover; Scoliosis worsens
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Male tanner stages
1: childhood 2: testicle enlargement w/ scrotal reddening 3: all 3 grow in size; length 4: all 3 grow; width 5: adult 2: sparse hair at base 3: dark/coarse/curled hair 4: adult hair not on thighs 5: adult hair including thighs
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Male Sexual Maturity Ratings Normal male puberty growth sequence
Table Testicular growth SMR 2 Pubarche Penile growth SMR 3 Peak height velocity SMR 4
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Breast mass in adolescent females are usually ? type and evaluated by ? What is a normal variant of puberty seen in peripubertal females and What causes this variant How is is evaluated
Fibroadenoma, cyst; eval w/ US Physiologic leukorrhea- clear vaginal d/c w/out odor/pruritus; Estrogen from ovary stimulating uterus/vagina Vaginal culture w/out speculum
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Menarche usually presents ? long after thelarche How long are these classified as irregular after onset How do Pts know when ovulation has set in
2-3yrs after 1-2yrs Cycle length 21-45 days
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# Define Premature Thelarche What can cause this What labs/rads need to be ordered
Isolated breast development in 6-7y/o female Estrogen exposure to phytoestrogens in soy, legumes, flax seed, tofu Estradiol, LH, FSH, bone age Head MRI, Pelvic US, GNRH stimulation test
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# Define Premature Adrenarche What are two etiologies for this variant What labs/rads need to be ordered
Body odor, pubic/axillary hair, acne in females <8y/o/males <9y/o Obesity, CNS injury DHEAS, Androstenedione, Testosterone, 17-OH, Bone age ACTH stimulation test, Adrenal/Pelvic imaging
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# Define Premature Testelarche What is the next step Why is this next step so important
Enlarged testis >3cc/2.5cm in male <9y/o Endocrine emergency 50% have brain tumor
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How is Male Gynecomastia evaluated When is further work up needed What medication may be used
Round, freely mobile, tender mass under areola in Tanner Stage 3 Large, Hard, Fixed or w/ d/c Bromocriptine
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When does irregular bleeding suggest organic abnormality may exist When is further evaluation needed for irregular menses Define Primary Amenorrhea and the MCC
1yr of regular cycles followed by irregular bleeds Two or more cycles that are not 21-35d, 7d/
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Menses frequency Menses regularity Menses duration Menses flow
Frequent: <21d/cycle Infrequent: >35d/cycle Amenorrhea: absent x 6mon/> Irregular: >20 day variation in cycle length Prolonged: >8 days Shortened: <2 days Heavy: >80cc loss Light: <5cc loss
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# Define Secondary Amenorrhea Criteria to Dx PCOS MCC of abnormal uterine bleeding in adolescents
Menses that have stopped x 3mon after menarche Two of: Hyperandrogenism Infrequent bleed/Secondary amenorrhea Polycystic morphology on ovary US Anovulation
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How is AUB Tx What is the mainstay of Tx for Pts w/ bleeding d/o such as Von Willebrand Dz Define Primary Dysmenorrhea
Fe therapy Combo E/P to regulate cycle and allow HPO axis to mature Combo E/P Pelvic pain DURING menstruation w/out pelvic pathology; Feature of ovulation developing 1-3yrs after menarche
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What causes the pain associated w/ dysmenorrhea MCC of Secondary Dysmenorrhea What is the initial screening study for Dysmenorrhea Evaluation
Prostaglandins and leukotrienes from degenerating endometrium after progesterone declines causing increased uterine tone; inc pain fiber sensitivity to bradykinin Endometriosis or PID Outlet obstruction w/ US
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How is Dysmenorrhea Tx When is referral/second opinion warranted What is the most important part of a Sports Physical
NSAIDs- first line therapy Failure= hormones Combo OCPs >4mon w/ persistence Hx
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What is an example of a disqualifying and non-disqualifying finding on sports physical How long are Peds disqualified from sports for Mono How many calories do boys/girls 14-18y/o need per day
MedHx of seizures that are controlled- not Stage 2 HTN/poorly controlled- dq'd 28d d/t risk for spleen injury B: 2000-3200 G: 1800-2400
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How much Ca/day do teens need When is a teen considered Obese and Morbidly Obese How is Obesity managed in Pts <7y/o and >7y/o
1300mg/day >120% ideal body weight >200% ideal body weight <7y/o: goal of weight maintenance to let linear height catch up >7y/o: goal is 1lb/mon until BMI is <85%
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What are the SMART Goals when managing Peds w/ obesity One in five adolescents are depressed and are at risk for developing ? ? has a higher rate of adolescent death than MVCs
Specific Measurable Attainable Realistic Timely Bipolar d/o Suicide
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What are the only two meds approved for depression Tx in children How often are Pts f/u w/ after starting meds ? is the MC psychiatric d/o of childhood
Fluoxetine, Escitalopram Weekly x 2mon Anxiety
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Substance abuse screening acronym Done w/
``` CRAFFT: Car- driving under influence Relax- using drugs to relax/fit in Alone- alcohol/drug use while alone Forget- d/t consumption Fam/Friend- tell teen to stop/cut down Trouble- d/t substance abuse ``` Slide deck 7
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How does Post-Strep Glomerulonephritis present How are these Pts managed
Hematuria, Periorbital edema, and HTN two weeks after strep pharyngitis or 3-6wks after strep skin infection Dx/Tx ABX if active infection Volume overload w/ Furosemide/fluid restriction Dialysis if severe renal impairment
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How does Henoch Schnelein Purpura/IgA Vasculitis present What will lab results show
Purpuric rash, Abdominal pain, Arthralgia, Arthritis 1-3wks after URI Normal platelet counts Heme-pos stool Proteinuria w/ elevated BUN/Cr
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? is the MC solid renal tumor in kids <15y/o ? is the imaging method of choice What medication can be used to help reduce the cosmetic effect of Acanthosis Nigricans
Wilms tumor US then CT w/ contrast Topical retinoids
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Name of microbe causing pinworms How is this Tx
E. vermicularis Me/Al-bendazole and w/ repeat dose at 2wks Pyrantel pamoate
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How does acute urticaria present What is first line therapy
Raised, erythematous plaques w/ central pallor w/ intense pruritus Second generation H1 antihistamine: Levo-Cetirizine- citrus magazine Des-Loratadine- low-riding jeans Fexofenadine- fox fencing
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? is the MC abnormality of male GU tract What is the MC location of this MC abnormality When is surgical intervention indicated
Cryptorchidism High scrotal > Inguinal canal > abdominal Undescended at 6mon= orchopexy
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# Define Rumpel Leede phenomenon seen w/ RMSF Name of tick carrier How is it Tx
Petechiae formation after BP cuff Dermacentor Doxy Chloramphenicol if preg/allergic to tetracyclines
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Criteria for Kawasaki Dz Dx What will lab results show What inflammatory markers will be elevated or normal How is this Tx What unique GI finding is associated w/ this Dx
``` Fever 5d or more w/ 4 of the following: Bilateral conjunctival injections Oral mucus membrane changes Peripheral extremity erythema/edema/desquamation Polymorphous rash Cervical lymphadenopathy ``` Thrombocytosis Leukocytosis Normocytic anemia +: CRP, ESR, A-1 antitrypsin -: ANA, RF High dose ASA and IVIG w/ f/u at Cards for Echo Hydrops of Gallbladder: pain, jaundice, boggy on US
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Testicular torsion is corrected w/ in ? time frame and w/ ? procedure How is pain described Stopped on
<6hrs w/ bilateral orchiopexy Radiating towards abdomen Rosh #10
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? is most frequently reported as perpetrator of child abuse Who is more likely to inflict serious head/abdominal trauma ? is the MC type of abuse that is also ?
Mother Father/Maternal boyfriend Neglect- failure to provide for child's needs; also hardest to document/prove
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? is the 2nd MC type of abuse ? is the MC type of emotional abuse ? are six complications that can arise from abuse
Physical, non-accidental trauma; MC perp is primary care giver Verbal Aggression Relationships Language Depression Substance abuse Sleep/Anxiety d/os
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What would be seen on PE if child was experiencing neglect ? types of Fxs have high abuse suspicion Abdominal injuries are more common in ? populations
Type 1 growth deficiency: normal head/length, low weight Metaphyseal Scapula Rib Spiral Vertebral Infant/Toddler
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? type of abuse is the leading cause of morbidity/mortality How does the color of a bruise correlate to age
Head injuries- shaking or blunt/force trauma ``` Red: 0-2d Blue/Purple: 2-5d Green: 5-7d Yellow: 7-10d Brown: 10-14d Hbg to Biliverdin to Bilirubin ```
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What image is done for suspected abuse in kids <3y/o Sequence of events for Fxs to heal
Skeletal surveys 7-14d: new bone/callus 14-21d: loss of Fx line, callus matures 3-6wks: dense callus >6wks: sclerotic thickening
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? is the Shaken Baby Triad Sexual assault kits can be collected w/in ? time frame Diabetes is characterized by ? and ?
Retinal hemorrhage Brain swelling Subdural hematoma <72hrs from attack Hyperglycemia and glycosuria
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What are the two type of DM in Peds Criteria for Pre-Diabetic and Diabetic
DMT1: MC type in childhood d/t autoimmune destruction of B-islet cells leading to permanent insulin deficiency DMT2: MC in adulthood d/t insulin resistance and obesity Pre: A1c 5.7-6.4 DM: Fasting 126 or higher 2hr OGTT 200 or higher A1c 6.5% or higher
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? is first line medical therapy for DMT2 Tx What are the 4 phases of DMT1 What are the 3 Ps of DMT1 presentation
Metformin Pre-clinical B-cell destruction Clinical onset Transient remission w/ honeymoon Established diabetes Poly-dipsia/uria/phagia
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Potential fatal outcome from undetected/poorly acknowledged DMT1 What are the 3 classifications of this outcome
DKA: glucose >300, pH <7.3, BiCarb <15 Mild: Co2 16-20, pH 7.25-7.35 Mod: Co2 10-15, pH 7.15-7.25 Sev: Co2 <10, pH <7.15
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How is DKA Tx What is the most serious complication from this Dx and how is it Tx What RF places Pt highest risk for developing this outcome
Admit for insulin/fluid w/ E+ therapy Switch D5W when glucose 250-300 10% once glucose <200 Cerebral edema; IV Mannitol w/ HOB raised Dec in glucose >100mg/hr
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How is DKA Tx What is the most serious complication from this Dx and how is it Tx What RF places Pt highest risk for developing this outcome
Admit for insulin/fluid w/ E+ therapy Switch D5W when glucose 250-300 10% once glucose <200 Cerebral edema; IV Mannitol w/ HOB raised Dec in glucose >100mg/hr
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What should DM diet compose of What are the A1c goals for Peds What are the blood glucose goals
55% carbs 15% protein <30% fat <300mg/24hrs cholesterol <6y/o: 7.5-8.5% 6-13y/o: <8% 13-18y/o: <7.5% <5y/o: 80-180 School aged: 80-150 Adolescent: 70-130
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# Define Honeymoon Period seen in DMT1 Define Dawn Phenomenon Define Somogyi Phenomenon
Residual B-cell function, measured w/ C-peptide Inc morning glucose d/t GH release and fading insulin levels; Tx w/ inc bedtime insulin Hypoglycemic level at 0300 d/t counter regulatory effect; Tx w/ lower bedtime insulin
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MC complication of DMT1 and when is it most likely to occur How are Mild or Sev complications Tx What f/u do these Pts need
Hypoglycemia; after hypoglycemic episode d/t reduce autonomic responses Mild: PO glucose Sev w/ seizure/LOC: glucagon Annual Ophth for Pts w/ dx >3yrs Annual UA for microalbuminuria Annual cholesterol/BP checks Annual thyroid
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Sick Day Rules for DMT1 What is the rule used for insulin insensitivity and establishing sliding scale
BG >240= check for ketones w/ fluid/insulin management Insulin pump- change site, give correction dose via injection Re-check BG/mental status q3hrs Re-check ketones qVoid Min 8oz sugar free fluid/hr 15g carbs/hr Rule of 1500: 1500/total insulin= amount 1unit of insulin will lower glucose
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? is the most sensitive test of thyroid function in Peds ? is the MC cause for this most sensitive to be elevated if on corrective meds Only indication to US thyroid in Peds
TSH Non-compliance Nodular; No if symmetrical