Peds Flashcards
What can occur in peds patients who are malnourished and receiving increased nutrition?
Refeeding syndrome (severe shifts in electrolytes & fluid)
Potentially fatal
What is the goal weight for obesity in children?
< 85% BMI for the pts age
What is the difference between anorexia nervosa and bulimia nervosa?
Anorexia: restricted eating due to fear of weight gain and/or body image disturbance
Bulimia: recurrent episodes of binge eating with a sense of lack of control/guilt which may include recurrent episodes of purging
What BMI is common to see in pts with anorexia nervosa?
< 18%
What are the 2 subtypes of ADHD?
Inattentive
Hyperactive
For a diagnosis of ADHD, where should symptoms be present?
In multiple settings
What is the treatment for ADHD?
Stimulants (amphetamines, methylphenidates)
SNRI (atomoxetine), NDRI (wellbutrin), TCA (amitriptyline)
Alpha-agonists (clonidine, guanfacine)
What are contraindications to children playing sports?
Active myocarditis or pericarditis
Acute enlargement of spleen or liver
Recent concussion & symptoms of postconcussion syndrome
Hypertrophic cardiomyopathy
Long QT syndrome
Athletes w/bleeding disorders should not do contact/collision sports
Which autosomal trisomies are not compatible with long-term survival?
Trisomy 13 (patau syndrome) (3rd most common)
Trisomy 18 (Edward syndrome) (2nd most common)
What are the signs/symptoms of trisomy 13?
Microcephaly
Anophthalmia/microphthalmia
Abnormally shaped/low-set ears
Rocker bottom feet
Weak muscle tone at birth
What are the signs/symptoms of trisomy 18?
Pinched face appearance
Clenched fists w/overlapping fingers
Club/rocker bottom feet
What is the most common autosomal trisomy?
Trisomy 21 (down syndrome)
What are the signs/symptoms of trisomy 21?
Flat facies
Brushfield spots in iris
Prominent epicanthic folds
Flat occiput
Simian crease
What is the average life expectancy of a person born with trisomy 21?
60 yo
What disorder is characterized by males being born with 2 or more X chromosomes?
Klinefelter syndrome
What are the signs/symptoms of Klinefelter syndrome?
Increased height
Long extremities
Gynecomastia
Delayed/incomplete puberty
Speech/language delays
What treatment is required for life starting in adolescence in pts with Klinefelter’s?
Testosterone
What disorder is characterized by females born with 3 X chromosomes?
Triple X syndrome
What are the signs/symptoms of triple X syndrome?
Increased height
Weak muscle tone
Kidney abnormalities
Increased of menstrual irregularity/infertility
What disorder is characterized by males born with 2 Y chromosomes and 1 X chromosome?
XYY syndrome
What are the signs/symptoms of XYY syndrome?
Increased height
Dental abnormalities
Scoliosis
Hand tremors
What used to be thought about people with XYY syndrome but has been disproven?
That they are aggressive/violent
What is the most diagnosed inherited cause of intellectual disability in males that is caused by a genetic abnormality of an X chromosome?
Fragile X syndrome
What are the signs/symptoms of fragile X syndrome?
Physical/intellectual/behavioral problems
Large protruding ears
Prominent chin/forehead
Large testes
Hyperflexible joints
What is the most common sex chromosomal abnormality in females who are born with 1 of 2 X chromosomes partially or completely missing?
Turner syndrome
What are the signs/symptoms of Turner syndrome?
Short stature
Webbed neck
Low posterior hairline
Shield chest
Amenorrhea
Absence of puberty
What IQ score is indicative of an intellectual disability?
< or = 70
What medications are commonly used in pts with intellectual disabilities?
Aggression/impulse control: anticonvulsants or lithium
Anxiety/self-injurious behaviors: clomipramine, SSRIs, buspirone, naltrexone
What are the signs/symptoms of Prader-Wili syndrome?
Obesity
Decreased muscle tone
Decreased mental capacity
Sex glands produce little or no hormones
What disorder is characterized by excess copper being deposited into the body tissues?
Wilson’s disease
What are the signs/symptoms of fetal alcohol syndrome?
Low IQ
ADHD
Faces w/broad set eyes
Narrow eye slits
Flat cheeks
Thin upper lip
Growth retardation
What are the signs/symptoms of Autism spectrum disorder?
Sensory sensitivity
Limited eye contact
Repeat/echo words
Difficulty w/schedule changes
Fixate on objects or sounds
Difficulty interacting
Repetitive behaviors
What is avoidant/restrictive food intake disorder (ARFID)?
Eating/feeding disturbance based on sensory characteristics w/failure to meet appropriate nutritional needs
What is the FDA medication and off label medication used to treat ARFID?
No FDA approved treatment
Periactin (cyproheptadine) off label
What medication can be used when conservative management fails for enuresis?
Desmopressin
What disorder is characterized by severe, recurrent temper outbursts, irritability/anger most of the day nearly every day?
Disruptive mood dysregulation disorder (DMDD)
At what age do you provide pharm treatment for depression in pediatrics?
Fluoxetine (prozac) at age 8
Sertraline (Zoloft) or Escitalopram (Lexapro) at age 12
What are the signs/symptoms of oppositional defiant disorder (ODD)?
Loses temper
Easily annoyed
Angry/resentful
Argues with adults
Actively defies rules
Deliberately annoys others
Blames others
Spiteful
What is a precursor to antisocial personality disorder?
Conduct disorder
What are the signs/symptoms of tetralogy of fallot?
Hypercyanotic episodes (“tet spells”)
SOB
Restlessness
Gasping
Syncope
What are the 4 ways tetralogy of fallot can occur?
Overriding aorta
R ventricle hypertrophy
Ventricular septal defect
R ventricle outflow tract obstruction
What will you see on a CXR in a pt with tetralogy of fallot?
Boot sign
What disorder has an egg on a string appearance on CXR?
Transposition of great vessels
What disorder is due to a single artery arising from the heart that supplies both the aorta and the pulmonary artery?
Truncus arteriosus
What disorder is due to the failure of the tricuspid valve to develop which leaves no connection between the right atrium and right ventricle?
Tricuspid atresia
What is the mainstay treatment for cyanotic heart lesions?
Oxygen and prostaglandins
Which cyanotic heart condition is most common overall, and which most commonly requires hospitalization in the first 2 weeks of life?
Overall: tetralogy of fallot
Hospitalization: transposition of great vessels
What is the most common acyanotic congenital heart lesion?
Ventricular septal defect
What are the different types of innocent heart mumurs?
Still’s (vibratory) (most common)
Venous hum
Pulmonary ejection murmur
Carotid bruit
Peripheral pulmonary stenosis (most common in 1st year of life but resolves)
Are innocent murmurs systolic or diastolic?
Systolic
They are NEVER diastolic
