Peds 2 Flashcards
What is the caloric requirement of most healthy term babies in the first 1 to 2 months of life?
100 kcal/kg/day
Term infants 100-120kcal/kg/day
Preterm infants 115-130kcal/kg/day
Very preterm infants 150kcal/kg/day
When do these primitive reflexes disappear? Moro Palmar Plantar Asymmetric tonic neck reflex Babinski
Moro - 4mo
Palmar - 2-3mo
Plantar - before child takes steps (1 year?)
Asymmetric tonic neck reflex - before child reaches for objects in or across midline (5mo?)
Babinski - 2yo
s/s: yellowish, greasy scales over the scalp, often called “cradle cap.” But it can also present as erythematous plaques around ears, eyebrows, nasolabial folds, and skin folds of the neck, axillae, and diaper area
What is this?
seborrheic dermatitis
What vaccines are given during a 2 month WCC?
2 B DR HIP
HPV, DTaP, RV, Hib (Haemophilus influenzae), IPV (polio), PCV (pneumococcal)
What vaccines are given during a 4 month WCC?
4 DR HIP
DTaP, RV, Hib (Haemophilus influenzae), IPV (polio), PCV (pneumococcal)
What vaccines are given during a 6 month WCC?
B DR HIP In 6 months
HBV, DTaP, RV, Hib, IPV (polio), PCV (pneumococcal), Influenza (flu)
*maybe/optional - can be given later or not depending on type of vaccine
A child is able to sit without support and waves bye-bye. How old is this child if developmentally appropriate?
9 months old
9-month-old girl noted to have a RUQ mass and pallor. There is no lymphadenopathy, splenomegaly, or jaundice.
Imaging: The mass is retroperitoneal and of nonrenal origin. It is heterogenous in consistency. There is local spread to the kidney.
Bone marrow pathology: Marrow involvement, and small cell rosettes are seen.
Bloodwork: normocytic anemia
Urinary catecholamine values: elevated
Dx?
Neuroblastoma
A 36-month-old presents for a well child visit. The parents would like to know if the child’s development is progressing appropriately. The child passed a hearing test at birth, and other than a few URIs, has been generally healthy. The child has not had any hospitalizations or serious illnesses. The child is able to run well, walk up stairs, walk slowly down stairs, uses more words than the parents are able to count, but can only use them in short, two or three-word sentences. The child’s speech is understandable and the child can draw a circle, but not a cross. Neurological examination reveals normal cranial nerves, normal sensitivity, normal motor reflexes, and no Babinski sign. Which of the following is the next best step in management of this child?
Reassure the parents that the child’s development appears normal
A healthy male child brought into your office by his mother for a well-child examination. As part of your evaluation you assess his developmental milestones. He is able to run, make a tower of 2 cubes, has 6 words in his vocabulary, and can remove his own garments. What would you estimate this child’s age to be based upon his developmental milestones?
18 months
A 5-month-old male is brought to the urgent care clinic with a 3 day history of rhinorrhea and non-productive cough. At birth the baby was large for gestational age and exam at the time was notable for macrocephaly, macroglossia, and hypospadias. Vital signs are stable on physical exam at this time. There is copious nasal discharge, but lungs are clear to auscultation. On abdominal exam, you palpate an abdominal mass on the right side just below the subcostal margin. It is 7 cm in diameter and does not cross the midline. The abdomen is soft and non-tender with active bowel sounds. What is the most likely cause of his mass?
Wilms’ tumor
An asymptomatic, healthy 9-month-old is found to have a palpable RUQ mass on exam. After further imaging and lab studies, the mass is diagnosed as a neuroblastoma that has involvement in the bone marrow as well. The mother is worried about the prognosis. Which of the following is true about the prognosis of neuroblastoma in this child?
A. Children who are older than 12 months have a better prognosis than younger children
B. Favorable histology does not play a role in prognosis
C. Lymph node involvement is a poor prognostic factor
D. Non-amplification of the n-myc gene is a favorable prognostic factor
E. Prognosis of neuroblastoma is predictable
Non-amplification of the n-myc gene is a favorable prognostic factor
A 9-month old comes to the clinic for a well-child visit. The child is at the 50th percentile for weight, length, and head circumference and is reaching all developmental milestones appropriately. The mother has no concerns at this visit. The child has previously received the following vaccines: 3 doses of DTaP, 3 doses of Hib, 2 doses of HepB, 3 doses of RotaV, 2 doses of IPV and 3 doses of PCV13, and no influenza vaccines. Which vaccines should the child receive at today’s visit?
Influenza, Hep B, IPV
A 10-month-old asymptomatic infant presents with a RUQ mass. Work-up reveals a normocytic anemia, elevated urinary HVA/VMA, and a large heterogeneous mass with scant calcifications on CT. A bone marrow biopsy is performed. What histologic findings on bone marrow biopsy is most consistent with your suspected diagnosis?
Small round blue cells with dense nuclei forming small rosettes
Suspect dx is neuroblastoma
What is the initial workup for a child presenting with an abdominal mass?
CBC w/ diff, catecholamine metabolites, CXR, bone scan, abdominal US/xray/CT
