Peds Flashcards
1
Q
Virus causing- Roseola
A
Human Herpesvirus 6
2
Q
Virus causing- Fifths disease
A
Parvovirus B19
3
Q
Virus causing- Rubella
A
Rubella virus
4
Q
Virus causing- Rubeola aka——-
A
Measles
Rubeola virus
5
Q
Virus causing- Chicken pox aka——
A
Varicella zoster- herpes
6
Q
Virus causing- Herpangina
A
Coxsackie A virus
7
Q
Virus causing- Hand, foot and mouth?
A
Coxsackie virus A16
8
Q
Maculopapular rash “ brick red” starts on the head and neck spreads to trunk and extremities
A
Measles aka rubeola
9
Q
Slapped cheek rash; lacy; macular rash
A
Fifths disease aka erythema infectiosum
10
Q
Maculopapular rash, looks like measles rash, remarkable lymphadenopathy, macules on soft palate (Forschheimer spots)
A
Rubella
11
Q
High fever, 2-4 days, abrupt end + maculopapular rash- not on face
A
Roseola/ exanthem subitum
12
Q
Vesicular lesions on erythematous base appearing in crops
A
Chickenpox
13
Q
Exotoxin Rash secondary to group a strep infection, sandpaper like rash that desquamates
A
Scarlet fever
14
Q
Exanthem subitum
A
Roseola
15
Q
Erythema infectiosum
A
Fifth disease
16
Q
Forscheimer spots
A
Macules on soft palate- Rubella
17
Q
Lacy macular rash
A
5ths disease
18
Q
When can a child with a viral exanthem return to daycare/school
A
24 hours without fever
19
Q
When can a child with chickenpox return to daycare/school
A
When all the vesicles have crusted over + 24h fever free
20
Q
Group A Step can be followed by what viral Exanthem
A
Scarlet fever
21
Q
What disease manifests as vesicles that rupture and produce painful ulcers on the soft palate in the mouth
A
Herpangina
22
Q
What viral infection can cause pass on the tonsils
A
Mono
23
Q
What is the usual age to see roseola
A
7-13 months
24
Q
What age and time of year is hand foot and mouth disease most common?
How long does it take to resolve?
A
- < 5y/o
- Summer months
- 2-3 days
25
Three C’s of Measles/ Rubeola
Conjunctivitis
Coryza (runny nose/ congestion)
Cough
26
1-3mm Whitish, blueish or gray elevations on the buccal mucosa, hard and soft palate
Kopliks spots —— Measles!!!
27
Bulging, cloudy tympanic membrane, decreased mobility, +/- redness
AOM
28
Common pathogen for CAP? Treatment?
S. pneumo
Amoxicillin
29
Croup treatment
Single oral dose / dexamethasone
30
Sickle cell disease goals of care?
Prophylaxis abx?
Keep them healthy!
Infections cause sickle cell crisis!
—-Penicillin prophylaxis
31
Lead toxicity masks as—
IDA- microcytic anemia
32
Screening test CF
Sweat test
33
Recurrent lower Resp infections in a kid, + greasy stools, + weight loss—- think?
CF
34
When spacing immunizations, what is the maximum days a vaccine can be given early?
4
35
MMR & Varicella vaccine type?
When given/ spaced?
Live attenuated vaccines
Given together at 1 year
If NOT Given together, wait 4 weeks before giving the second
36
When are these lymphnodes classified as enlarged?
Epitrochlear-
Inguinal-
Cervical-
Epitrochlear- >5mm
Inguinal- >15mm
Cervical- >20mm
All others >10mm
37
When treating children with headaches- avoid daily analgesic use due to
Rebound headaches
38
Projectile, nonbilious vomitting-
Pyloric stenosis
39
Pyloric stenosis is most common at what ages
4-6 weeks
40
Pyloric stenosis is diagnosed via what imaging-
What clinical signs suggestive emergency referral?
Ultrasound
Unable to keep fluids down
41
“Olive shaped mass” think——
Pyloric stenosis
42
Red flags with presentation of reflux
Choking/ coughing with eating
Refusal to feed
Forceful vomit
GI bleeding
Poor weight gain
Fever
Abdo pain
Bowel changes/ constipation or diarrhea -?bowel obstruction
43
GER is likely to resolve by what age
1 year
44
In children with GER- what non-pharm management tips? X5
Breast feeding!
Place supine to sleep
Small, frequent, thickened meals- rice cereal
Avoid tobacco smoke exposure
Trial other formulas ie. non cows milk, hypoallergenic formula- 1-2 week trials
45
Acid suppression therapy in children should be used for how long?
Trial 2 weeks, if no improvement- refer to GI
If improved- continue for 2-3 months then TAPER
46
Colicky abdo pain, red current jelly stool, ++ pain, child hunched over
Intussusception
47
What age range is most common for intussusception
3 months to 2 yrs
48
Treatment of constipstion in kids- pharmacological
PEG daily until normal stools- 1 soft BM/day
Then taper
49
-Can mothers breast feed baby with viral gastroenteritis?
-Are antidiarrheals recommended in children with gastroenteritis?
-Are anti-emetics recommended in children with gastroenteritis?
-Yes
- No & No- get it out!
Except if unable to keep fluids down/ becoming dehydrated
50
Oral fluid replacement for mild & moderate dehydration?
Mild- 5 tsp/ lb in 4h
Mod- 10 tsp/ lb in 4h
51
Cryptorchidism
Undescended teste- not in scrotum
52
Retractile testes
Move between scrotum and inguinal ring via cremasteric reflex
Ages 5-6 yrs
Can be concerning if doesn’t stay down
53
Refer child to Urology if testicles are not palpated in scrotum by ——-?
6 months
54
When should hydrocele resolve in an infant?
Etiology?
12 months
Hernia
55
What is the most common cause of UTI in children (40%)
Vesicouretal Reflex
Refer to Urology
56
Gold standard diagnostic for UTI in kids?
Get specimens and culture
57
Best diagnostic test for vesicouretal reflex
Voiding cystourethrogram
58
UTI in child < 2yrs warrants what diagnostic test?
KUB US
59
EmpIric Antibiotic treatment for UTI in peds- Afebrile vs febrile?
1st gen Cephalosporin- Cefixime
Afebrile- 3-7d
Febrile 10-14d
60
Kawasaki mnemonic-
CRASH & Burn
C- conjunctivitis- non purple t
R- rash, polymorphic, macular
A- adenopathy- cervical
S- strawberry tongue / swollen lips
H- Hands +/- feet swollen!!!!!
Burn- fever >5d
61
Work-up for suspected kawasakis?
CBC, CRP/ESR, ALT/AST
UA
Throat culture- r/o GAS
62
Kawasaki is a vasculitis of
Medium sized vessels
63
Treatment of Kawasakis dx
ASA +/- IV IG
64
Strawberry tongue- 2 diff
Kawasaki disease
GAS
65
Nurse Maids Elbow
When annular ligament slips over radial head
66
Reducing nurse maids elbow
1. Extend elbow
2. supinate F/a
3. Flex elbow
67
Acute lymphocytic leukaemia clinical findings
++ elevated WBC
> 50 000 cells/mm3
Affects immature white cells- lymphoblasts
68
Acute myelogenous leukemia
Fast growing cancer of the bone marrow
Affects WBCs, RBCs, Platelets, macrophage, monocutes
69
Hx of febrile viral illness + ASA/ salicylate intake- causes what serious illness
Reye’s syndrome
70
1. Severe vomitting, lethargy, diarrhea, elevated AST/ALT
2. Personality changes, aggressive behaviour, hyperactive reflexes
3/4/5- confusion, delirium, cerebral edema, coma, seizures, death
Reyes syndrome
71
Theoretical risk of Reye’s syndrome after what vaccine-
Recommend not using what medication before during or after
Varicella
Aspirin
72
All kids with Down syndrome who want to participate in sport require what imagine
C-spine
Due to atlantoaxial instability = increased distance between C1 and C2
73
Systolic murmur, musical/ vibratory quality, louder when supine, grade 1-2
Stills murmur
74
All children aged ——- should have received single dose quadrivalent meningococcal vaccine
11-12yrs
75
At 11 & 12 yrs- what vaccines are needed (x3)
Tdap
HPV
MCV4
76
Earl abstract thinking stage occurs at what age
11yrs
77
Molloscum is caused by what virus?
Pox
78
HPV vacc can be given at the earliest-
9yrs
79
Large head circumference, cognitive disability, long face, prominent forehead, jaw, large ears. Large body, flat feet.
Fragile X syndrome
80
Hand-foot- and mouth management
Symptomatic care
Self-limiting
Resolves in 5-7 days
81
Pel-Ebstein sign
Supraclavicular lymph nodes with fever
Hodgkin Lymphoma
82
Congenital tumour of the kidneys that rarely crosses midline
Wilms tumour
83
Child presents- sitting posture, hyperextended neck, open mouth breathing
Epiglottitis
84
Speech of a ——- year old should be understood by family
2 y/o
85
Speech of a ——- should be understood by strangers
3 y/o
86
Ride a tricycle by —-
Ride a bike by ——
3 yrs
6-7 yrs
87
Can draw a circle by age
3
88
—- y/o can cope a cross
4
89
Oedipal stage
When a child wants to marry parent of opposite sex
Ages 3-6yrs
90
Can draw a stick person with 3 body parts by age-
6 body parts by age-
4yrs
5yrs
91
Rear facing car seats until age?
2 yrs
92
Kids are ready for potty training at what age?
18-24 months
May not be ready at 36 months
93
Complete bowel/bladder control in the day is achieved around ——-
Complete control at night is achieved by ——
Day- 3-4 y/o
Night- 4/5 y/o
94
Pointing/ waving/ grasping by age
12 months
95
5 behavioural signs suggestive of autism
1. No wave/grasp/point by 12 months
2. No cooing/babbling by 12 months/ no words by 16 months
3. No 2 word phrases by 24 months
4. Any regression in language or social skills by 24 months
5. No gesturing (wave/point/grasp) by 24 months
96
T/F. At 3 years old- it would be expected for a child to cry, scream and cling to mother when dropped off at a day care.
True- if suspected autism- child will not demonstrate these behaviours
97
Nephroblastoma aka ——-
More common in what patients-
Peak age-
Wilms tumour
African American female sex
2-3 yrs
98
Epiglottitis is most common between ages—-
Most common pathogen?
2-6 yrs
H. Flu- Hib vaccine greatly reduced incidence
**reportable disease
99
What assessment finding would require you to r/o congenital hip dysplasia or hip fracture in an infant
Asymmetry of thigh/ gluteal folds
100
Rolls from front to back by ——
6 months
101
Plays pat a cake by —-
9 months
102
Most common ages to screen for hip dysplasia
Birth to 3 months
103
Assessing for hip dysplasia in older infants x3
1. Leg turned outward
2. One femur appears shorter than the other when infant is supine aka Galeazzi sign
3. Limited hip ROM
Ultrasound hip and send to ortho!
104
Booster seats are to be used in cars until when-
Child is 8-12 years old
Or 4’ 9”
105
Neonatal unconjugated hyperbilirubinemia & neonatal icterus aka———-
Appears when-
Resolves when-
Physiologic jaundice
-After 24 hours
-2-3 weeks
106
Breast Milk Jaundice
Onset-
Peak-
Time to clear-
After 7 days of life
Peaks 2-3 weeks
Can take more than 4 weeks to clear
- cause is suspected not enough breast milk
107
Conjugated hyperbilirubinemia aka——
Onset-
Pathological Jaundice
Birth / within 24h
108
Specific test used to evaluate suspected pathological jaundice in new born
Coombs test***
109
Hemoglobin drops at the lowest levels in life at 6-8 weeks
Physiological anemia of infancy
Temporary decreased in EPO prod of kidneys
110
Dacryostenosis
Congenital nasolacrimal duct obstruction
Occurs in up to 20% of newborns
Spontaneously resolves in 6 months (95%)
111
Acute dacryocystitis is usually caused by what pathogens?
Length of abx tx?
** assess for progression to —-
Strep & staph
7-10 days
Orbital cellulitis
112
How to perform lacrimal sac massage
Finger on lacrimal sad and massage downward towards mouth
Perform 2-3 times a day
113
Infant Colic rule of 3s
1. < 3 months old
2. Crying > 3h a day *usually the same time each day
3. Crying > 3 days per week
Usually resolves by 3-4 months
114
Coarctation of the aorta
How to assess-
Palpate brachial and femoral pulses simultaneously
Diagnostic = absence or delay of femoral pulse compared to brachial
115
Normal vs abnormal BP findings in infants-
1. Systolic BP is higher in legs than arms
2. Systolic higher in arms than thighs
Normal = Syst BP is higher in legs than arms
Concerned for coarctation of aorta if arm BP higher!
116
Post acetaminophen overdose, how long until labs will be accurate?
Antidote?
4h
Acetylcystein
117
Precocious puberty
M- <9yrs
F- <8 yrs
118
Delayed puberty
M- no testicular growth by age 14y
F- no breast development (Tanner 2) by 12y
119
In female sex- when does majority of skeletal growth take place- relative to menses
Before- slows after
120
Average age of spermarche
13.3 yrs
121
Unilateral midcycle pelvic pain that is caused by an enlarged ovarian follicle
Mittelschmerz
122
Menarche average age
12
123
After tanner stage ___ menses occurs within 1-2 yrs
2= breast bud
124
Delayed puberty if no 2nd sex characteristics by age
12-13y
125
Most fertile period in menstrual cycle is when
3 days before/ during ovulation - approx day 11-14
126
Enlarged lymph nodes with fever, night sweats, and pain after drinking alcohol
Hodgkin’s lymphoma
127
What tanner stage does puberty start and end at
Start at 2
End at 5
128
Describe tanner stages 2,3,4 in MALEs
2- testicular enlargement and colour darkens
3- elongation of the penis
4- penis thickens and increases in size- testes are larger and scrotal skin darker
129
Describe tanner stages 2,3,4 in FEMALEs
2. Breast bud formation
3. Breast tissue and areola form singular mound
4. Areola/ nipple separate to form secondary mound
130
Lanugo, peripheral edema, amenorrhea, and weight loss > 10% of body weight
Anorexia
131
No menarche by 15yrs +/- development of secondary sex characteristics
Primary amenorrhea
50% due to chromosomal disorders
132
No menses for 3 cycles or 6 months
Secondary amenorrhea
133
Most common cause of secondary amenorrhea
+ 2 diff
1st Pregnancy
Anorexia
PCOS
134
Measure bone density if amenorrhoea for more than
6 months
135
In adolescence with amenorrhea 2nd to execessive exercise/ weight loss- prescribe 3 supps
Vit D, Calcium, Vit E
136
Telogen effluvium
Form of hair loss- 2nd to stress response/ malnutrition
137
Gynecomastia is most common in what ages-
Course-
Peaks at age 14
40% pubertal males
Resolves in 6 months to 2 years
138
Adams forward bend test is used for assessment of ?
What other diagnostic is used in evaluation?
Scoliosis
Full spine x-ray
139
Treatment of Cobb angle (degree of spinal curvature) curve -
<20 deg
20 - 40 deg
> 40 deg
<20 deg - monitor
20- 40- brace
>40 - surgical correction
140
Causes primary hypogonadism
Testes are small and firm with small penis
Tall stature, wide hips, reduce facial and body hair, higher risk osteoporosis
What’s the condition?
Klinefelter syndrome
Extra X chromosome
141
Congenital lymphedema of hands & feet
Webbed neck
High-arch palate
Short 4th metacarpal
Short stature (<50%)
Turners syndrome
Partial absence of second sex chromosome
142
Bilateral enlarged breasts, soft to touch, nontender, no breast buds or disklike breast tissue palpable
Pseudogynecomastia
143
T/F- No parental consent is needed for health services related to sexual activity in adolescence
True
144
Low albumin may cause what clinical findings
Peripheral edema
145
Nevus simplex aka
Stork bite
Benign
146
Nevus flammeus-
Port wine stain
147
Ant Fontanelle close-
Post Fontanelle close-
Ant- 9- 18 months - open at birth
Post- 2-3 months - not always open at birth
148
Hypertelorism
Eyes spaced further apart
Associate with many syndromes
149
How long is breast-feeding considered sufficient nutrition?
When are foods initiate it?
6 months
4-6 months
150
What does introducing foods too soon increase risk of?
Atopic dermatitis and atomic sensitization
151
What is often recommended is the first food for a newborn
Single ingredient food.
Ie meat.
Rice is least allergenic
152
When to introduce juice?
When they can drink from a cup ie.6 months
153
Cows milk is introduced when?
12 months
154
Finger foods are introduced when?
8-10 months
155
Painful abdominal mass that’s fixed, firm, irregular and frequently crosses the midline
Neuroblastoma
Usually btw 1 & 4y
Initial imaging is US
156
Corneal light reflects and cover/uncover test are used for assessing
strabismus
157
A form of vision loss that is preceded by an inability for two eyes to focus on the same object at the same time
Amblyopia
158
At what age should Eye alignment occur
2-4 months
159
First teeth at what age?
What teeth?
All primary teeth should be in by what age?
6 months
Central incisors
2 yrs
160
Permanent teeth begin to come in at what age
6-8 years
Until 20 years
161
Fluoride supplementation at what age
6 months- when teeth come in
162
When should a infant be able to track and follow with both eyes
2-4 monthd
163
Visual acuity testing begins at what age?
3/4yrs
164
Visual acuity at 3 y/o?
At 6 y/o?
20/50
20/20
165
Serrous OM can persist for up to —-?
3 months
166
If BP in upper extremities is greater than lower extremities in an infant— think?
Coarctation of aorta
167
Normal progression of hip/leg orientation x 4 steps
Bow legs at 6 months
Straighten when walking
Valgus at 4 yrs
Correct and straighten in adolescence
168
Scoliosis is defined by what degree of curvature
>/= 10 degree
169
Ideal X-ray order for scoliosis
PA view full spine - cervical through to sacrum
PA rather than AP to minimize radiation from front
170
In an infant with in-towing, what warrants referral to ortho versus monitoring
Rigid metatarsus = refer
Inability to turn both feet to midline
If able to turn to midline bilateral - flexible metatarsus- tell care giver to turn feet to midline 10x every time they change their diaper
171
Cobb method via x-ray is used for what
Measuring scoliosis angle
172
When do babes double and triple their BW?
2x @ 6 months
3x @ 12 months
173
Head circ increases by ___ in 12 months
12 cm
174
Does caput succedaneum cross midline?
Ceohalohematoma?
Yes caput succedaneum
No cephalohematoma
175
Colostrum contains what
IgG antibodies
176
Strong Morro reflex at 6 months
Concerning- ? Brain damage
177
Youngest age for influenza vaccine
6 months
178
DTaP in ages?
TDaP in ages?
DTaP < 7y
TDaP booster at 11/12yrs
179
Indications for oral antibiotic treatment in AOM?
< 6 months old
> 6 months + bilateral / fever / ++ pain
180
Antibiotic treatment of AOM and common pathogens
S. pneumo, H. Flu
Amoxicillin (high-dose)
181
E. Colo, Shigella, and Campylobacter all cause what illness/ symptoms in children?
Acute bacterial gastroenteritis
Bloody diarrhea
182
When is depression screening recommended in adolescence?
Ages 12-18 yrs
Annually
183
Common cause of impetigo -
Trichophyton Rubrum causes-
Staph Aureus
Common cause of Tinea Corporis
184
When is spontaneous closure of umbilical hernias in infants less likely?
> 1.5cm
185
Chronic progressive leg pain, with limp, in hip/ thigh/ groin region.
PE- decreased ROM with internal rotation and abduction of the hip + atrophy of the thigh muscle.
X-ray = flattened or fragmented femoral head
Legg- Claves-Perthes
Ie. idiopathic avascular necrosis
Peak incidence 5-7y
186
Chronic progressive pain in the long bones with ‘sunburst’ pattern on x-ray
Osteosarcoma
187
An overweight adolescent presents with hip pain.
X-ray shows posteriorly displaced femoral epiphysis-
Slipped capital femoral epiphysis
188
Pertussis treatment?
How long can cough last?
Azythromycin
>8 weeks
