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AANP > Peds > Flashcards

Peds Flashcards

1
Q

Childhood ages

A
  • neonate 0-28 days
  • infancy 1st year of life
  • Toddler 1-2
  • preschool 3-4
  • school age 5-12
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2
Q

2 week old

A
  • visual prefrerence for human face - vision range 8-12”
  • hear high pitch voices best
  • reacts to crys of othe neonates
  • well-developed snse of smell
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3
Q

stepping reflex

A
  • walking motion made with legs and feet when heald upright
  • appears for the 1st 3-4 months then reappears at 12-24 months
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4
Q

rooting reflex

A
  • turning head and sucking when cheek stroked
  • no longer seen by 6-12 months
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5
Q

Moro/startle reflex

A
  • throwing out arms and legs followed by pulling them back to the body following sudden movement or loud noise
  • no longer seen after 16 weeks
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6
Q

Palmar grasp

A
  • grasping object placed in the hand
  • no longer seen by 2-3 months
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7
Q

Babinski reflex

A
  • stoking the sole of the foot elicits fanning of the toes
  • no longer seen by 6 months
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8
Q

neonate stomach size

A

day1 cherry size
day 7 apricot
day 30 egg

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9
Q

Infant feeding

A
  • exclusively breast fed for first 6 months
  • introduce compplementry foods no sooner than 4 months
  • continue breast feeding for 1 year or longer
  • if not breast feeding infant formula 1st year as major caloric source

baby should be back to birth weight by 2 weeks

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10
Q

Hyperbilirubinemia in newborn

A
  • immature intestinal tract cannot reduce bilirubin to urobilinogen for excretion

Onset >24
* Pathologic jaundice - less common
* caused by metabolic disorders, hmeolytic disorder, sepsis …
* Intervention: treat underlying illness, ensure adequate fluid intake, Phototherapy if total serum bili >25

Onset <24 - 2 wks
* physiologic jaundice - most common reason, usually in the first 4-5 days of life
*Breast milk jaundice - usually after 1 wk
* Intervention: ensure adequate fluid intake, phototherapy if t. billi > 25

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11
Q

Hyperbilirubinemia in newborn
labs

A
  • jaundice starts in the face and works its way down the body
  • labs are required to dx degree of jaundice

Direct (conjugated) bili: hemolyzed RBC able to be excreted; elevated due to: sepsis, intrauterine infection, severe hymolytic disease, biliary atresia…

Indirect (unconjugated) bili: hemolyzed RBC not able to be excreted; uaually related to positive Coombs test (Blood groups Rh, ABO incompatibility)

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12
Q

Chemosis - conjuntival edema

A
  • chemical irritation from neonatal chemoprophylaxis
  • chlamydial (inclusion) conjunctivitis - s/s 5-14 days post exposure, chemosis common. prevent via maternal screen. confirm with culture, treat with oral erythromycin x2weeks
  • Gonococcal conjunctivitis - incubation beriod after exposure 2-7 days . Ocular chemoprophylaxis at birth with erythromycin opthalmic ointment or silver nitrate minimizes risk
  • Neonatal adenovirus - common cold pathogen- causitive organism of viral conjunctivitis, usually with ecessive tearing, mildly red conjuntiva and URI symotoms
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13
Q

2 month milestones

A
  • from tummy can lift selft with 2 arms
  • resonds 2 sounds
  • smiles when smiled 2
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14
Q

4 month milestone

A
  • reaches 4 a toy or object
  • smiles 4 fun (spontaneously)
  • rolls from tummy to back
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15
Q

6 month milestone

A
  • looks like number 6 when sitting
  • rolls from back to tummy and back
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16
Q

6 to 8 months

A
  • able to sit up unsupported
  • transferrs objects from hand to hand
17
Q

12 months

A

beging to walk

18
Q

18 months

A

canname single word objects
copys adults
says no alot

19
Q

2 years

A
  • 2 word sentences
  • follows 2 step commands
  • walk up steps with help
  • bultds a tower with 2 blocks
20
Q

3 years

A
  • bulids 3 block tower
  • speaks in 3 word sentance
  • trides a trike
  • draw a circle
21
Q

Speech milestones

A
  • percent of words understadable by adult not in daily contact with child
  • 16-18 months 25%
  • 19-21 months 50%
  • 2-2.5 yrs 75%
  • 3-4 years nearly 100%
22
Q

develpomental redflags

A
  • 6 months: no big smiles or other warm joyful expressions
  • 9 months: no back and forth sharing of sounds, smiles, or other expressions
  • 12 months: lack of response to name, no babbleing, and/or no back and forth gestures, shuch as pointing, reaching, showing, or waving
  • 16 months: no spoken words
  • 24 months: no meaningful two-word phrases that don’t involve repeating
23
Q

Childhood anemia

A
  • most common type IDA - microcytic, hypochromic, elevated RDW
  • most common in children 12-30 months
  • depletion of birth iron stores (usually lasts till 6 months), initiation of lower-iron diet in later infancy, early todler stage
  • most calories in 1sy year should be from breast milk with iron supplementation statring at 4- 6 months unless iron fortified formula or foods
  • > 12 months, most potent risk factor for IDA is cows milk >16 oz/day
  • in <9 months, most potent risk is maternal iron depletion or preterm infant
24
Q

Diagnosis of AOM in children

A
  • moderate or severe buldging of TM OR new onset of otorrhea not related to otitis externa, and Otalgia
  • mild buldging of TM and recent (<48 hrs) onset of ear pain ( tugging, holding, rubbing) or Intense TM erythema with otalgia
25
Q

Management of AOM

A
  • treat ear pain - alagesics: acetaminophen or ibuprofen
26
Q

watchfull waiting for AOM

A

in otherwise well child may not need to immediately start abx:
* low risk of adverse outcome without ABx, high rate of spontaneous resolution without abx

analgesia without abx is acceptable if
* >6 months and unilateral infection with non severe illness based on joint decision with provider and parent. follow up in 48-72 hours with ability to start abx if no improvement or worsening

27
Q

severe vs nonsevere AOM in children

A

nonsevere
* mild otalgia for <48hours or
* fever < 39/102.2 in the past 24 hours

Severe
* moderate to sever otalgia or
* otalgia >48 hours or
* fever>39/102.2

28
Q

ABX tx for AOM at time of diagnosis

A
  • reguradless of severity or laterality if <6 months
  • severe illness with unilateral or bilateral in >6 months
  • nonsevere illness with bilateral AOM in young children 6-24 months
29
Q

1st line tx for AOM

A
  • amoxicillin 80-90mg/kg/d
  • amioxicillin-clavulante

length of therapy
* <2 yrs : 10 days
* 2-6 yrs: 7 days
* >6 yrs 5-7 days

30
Q

AOM with PCN allergy

A

cefdinir, cefuroxime, cefpodoxime

31
Q

Otitis media with effusion

A
  • fluid in middle ear without s/s of infection (anticipated finding after AOM)
  • 1st line: watful waiting - 75-90% resolve in 3 months without specific treatment (abx, oral antihistamines, decongestants not indicated)
  • consider audiologic eval if persists more than 3 months, or concers for hearing, speech, or language concerns after prior audiologic test - referal to ENT and/or speach therapy
32
Q

scarlet fever

A
  • S. pyogenes pharyngitis with sanpaper like rash
  • exudative pharangytis, fever, HA, tender localized anterior cervicle lymphadenopathy
  • rash usually reeupts on day 2 of pharyngitis and often peels away a few days later
33
Q

Roseola

A
  • human herpesvirus -6
  • yonger child with peack at 6-24 months
  • fever spike
  • discrete rosy-pink macular or maculopapular rash lasting hours to 3-days, follws a 3-7 dya period of fever, often quite high
34
Q

Rubella/3 day measles/german measles

A
  • mild symptoms - fever sore throat, malaise, diffuse maculopapular rash lasting about 3 days
  • Posterior cervicle and postauricular lymphadenopathy begining 5-10 days prior to onset and present during rash
  • Arthralgia in about 25% (most common in women)
  • risk in pregnancy to the fetus
  • vaccine preventable
35
Q

Rebeola/10 day measles/hard measles/measles

A
  • usually acute presentation
  • fever nasal discharge, cough, generalized lymphadenopathy, conjunctivitis (copious clear discharge), photophobia
  • Koplik spots - appearing 2 days prior to onset of rash as white spots with blue rings held within red spots in oral mucosa
  • pharyngitits is usually mild without exudate
  • maculopapular rash onset 3-4 days after onset of symptoms, my coalesc
  • vaccine preventable

AANP (20 decks)

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