Peds Flashcards
Major embryonic derrivatives and what they become (occurs up to 8 weeks then fetal stage begins) ectoderm, endoderm, mesoderm
Ectoderm: Epidermis, hair, nails, glands of skin, brain and spinal cord
Endoderm: Epithelial lining of glands and digestive/respiratory tract
Mesoderm: notocord, somite (vertebra and ribs), kidneys, gonads, heart and blood vessels
When babies should return to birth weight ***
by 2 weeks
weight loss of 5-10% is normal
APGAR scoring
Activity: active movement, some flexion of arms/legs, absent
Pulse: greater than 100, less than 100, absent
Grimace (reflex irritability): crying/acitve, grimace/some flexion, no response/flaccid
Appearance: pink, body pink/extrem blue, pale
Respiration: good/cry, slow/irregular, absent
Max score of 10… normal is 7-10, intubate if 0-3, 4-6 bag O2
Adverse effects of neonatal jaundice
Acute bilirubin encephalpathy
Kernicterus: unconjugated bilirubin crosses the blood-brain barrier and damages brain cells if levels above 20-25 mg/dL…s/s: poor feeding, decreased moro, tx exchange transfusion
Mechanisms of physiologic jaundice (peaks at 3 days of life)
bilirubin production is higher
bilirubin clearance by the liver is decreased
increased enterohepatic circulation
NOT physiologic if baby gets jaundice in first 24 hours (hemolysis)
Indirect Coomb’s test is a measure of…
RBC agglutination
tests the presence of blood type and antibodies in the serum
At one year of age how much should the child weigh?
triple their birth weight
Neonatal head exam (4)
Caput succedaneum: common! Crosses suture lines, normal finding
Cephalohematoma: blood collected below periosteum and DOES NOT cross suture line (usually parietal bone)
Craniosyntosis: premaute closure of sutures (usually sagittal which leads to A/P lengthening)
Craniotabes: ping pong ball feel of skull
Infant reflexes
Moro: Drop baby get symmetric abduction of extremeities, disappears in 5-6 mo’s
Grasp: finger in palm, dissapears by 2-3 mo’s
stepping: hold baby and wants to step
rooting: stroke cheek and will turn head towards, dissapears by 2-3 months
parachute: stomach in air will splay arms out, have for life
Positive babinski (toes splay) up to 1 year
4 month milestones
rolls over, laughs, orients voice, smiles
6 month milestones
sits independently, babbles, recognize faces, transfer block
9 month milestones
crawls, says mama, dada, waves bye, holds bottle
12 month milestones
walk, fine pincer grasp, a couple of words
24 month milestones
walks up and down steps, build block tower, 50 word vocabulary
3 year milestones
ride tricycle, copies circle, 250 word vocabulary with 3-word sentances
4 year milestones
hops, skips, knows colors
TORCH congenital infections
Toxoplasmosis Other (syphillis, HIV, varicella, Hepatitis) Rubella Cytomegalovirus Herpes Simplex
Congenital Toxoplasmosis triad
corioretinitis, hydrocephalus, intracranial calcifications
found in cat feces
Treat with Pyrimethamine (antiparasitic) and Sulfadizine
Childhood manifestations of congenital Syphilis
interstitial keratitis (blindness), hutchinson teeth (notched), 8th cranial nerve deafness, rash on hands and feet, snuffles (rhinitis with blood)
Tx Penicillin G
Dx IgM FTA-ABS (fluorescent treponemal antibody absorption)
Blueberry muffin rash seen in
Congenital Rubella
Congenital CMV features
Can cause deafness (sensorineural hearing loss)
most common congenital viral infection
Deletion 22q11 pertinent electrolyte abnormality
hypocalcemia
Turner syndrome features
XO
females only
webbing of neck, short stature, amenorrhea, failure of secondary sex characteristics
Klinefelter Syndrome
XXY
hypogonadism
boys with small testes and breast development, wide hips
Phenylketonuria (PKU) features
diagnostics at birth
hypopigmentation, seizures, mental retardation
Dietary restrictions of red meat, chicken, fish, eggs, cheese, dairy
AVOID Aspartame
Most common childhood cancer age 0-14
ALL
AML peripheral smear***
Auer Rods
see increased blast cells on smear
Hodgkins Lymphoma smear
Reed Sternberg cells
Routine Autism Screening at…
18 and 24 months
Sign of intestinal obstruction on XRay
Air fluid levels
1st line treatment for constipation in peds/ review of laxative agents
**Osmotic Laxatives: Polyethelene glycol (Miralax), Lactulose
Stool softeners (docusate sodium/colace) do not work
Bulking agents: psyllium (metamucil)
peristalic inducers: Senna (Ex-Lax)
Treatment of Enuresis
Despopressin
Imipramine (anticholinergic)
Enuresis alarm
Cover uncover test is for…
strabismus (misalignment of the two eyes)
esotropia: inward
exotropia: outward
Children will be esotropic until 5-6 months of age
Tanner Stages of Sexual Maturity
I: Preadolescence
II: Pubic Hair: sparse, downy Breast: buds and papilla Penis: slight enlargement Testes: enlarged scrotum
III: Pubic Hair: Increased pigmentation, more curly Breast: enlarged with no contour separation Penis: Increased length Testes: Increased size
IV: Pubic Hair: Adult type but less Breast: secondary mound Penis: glans enlarged Testes: enlarged, darker
V: Adult distribution
1 Cause of mortality in adolescents (5-15)
MVA
Preventable risk factors with SIDS
1: SMOKING cessation
pacifier use at night
“back to sleep”
Lead Poisoning presentation
ataxic gait, anemia, constipation, headache
Treat with chelating agent: Succimer
Most common etiology of Otitis Media
Strep Pneumo
PE: non mobile TM, bulging TM, decreased landmarks
Tx amoxicillin
***Scarlet fever presentation
Sunburn appearing maculopapular rash… sandpaper on erythematous base
occurs post strep
Epstein-Barr virus presentation***
Beefy red tonsils plus exudate posterior cervical lymph nodes splenomegaly afebrile Dx with HETEROPHILE antibody testing (monospot) CBC with increased lymphocytes
Hand foot and mouth caused by
Coxsackie virus
Croup casued by
Parainfluenza virus
Mumps presentation
Parotid gland swelling, aseptic meningitis, orchitis
can cause sterility in males
***HETEROPHILE antibody testing used to diagnose
Epstein Barr Virus (mono)
Koplick spots are pathopneumonic for…
Rubeola (Measles)
Rash is dark and mobiliform that starts at hairline and spreads to trunk arms and legs
Rubella (German Measles) features
Togavirus
presents with arthritis and arthralgia and a rash that does not coalesce
Roseola
HHV 6
high fevers followed by a rash
Fifth disease (erythema infectiousum)
slapped cheek disease
Parvovirus B19
NOT contagious once rash appears
Pertussis presentation
cough for over 2 weeks
paroxsysmal whoop
“cough so hard vomiting occurs”
Treat with erythromycin
Live virus vaccines
MMR
Varicella
Zoster
Nasal-Spray flu vaccine
Salter-Harris Classification
I: Nondisplaced through metaphysis II: fx into metaphysis III: fx through epiphysis IV: fx through metaphysis and epiphysis V: Crush injury
*** Presentation of Impetigo
Honey colored crusts
strep or staph
Treat: Topical Bactroban… coverage against staph and strep, PO: Septra, Clinda, Augmentin
Syphilis Features
Caused by Treponema pallidum primary: painles sore/chancre secondary: copper penny rash on hands/feet tertiary: brain, hear, nerve damage Tx: IM penecillin G Dx: FTA-ABS
Most common bacterial STI in the US
Chlamydia
75% are asymptommatic
***N. Gonorrhoeaee gram stain
Gram negative intracellular diplococci
HPV of genital warts and cervical dysplasia
Warts: 6 and 11
Cervical cancer: 16, 18, 31, 33, 35
Diagnostic testing for contact dermatitis
Atopy patch testing (for delayed hypersensitivity T-Cell mediated reaction)
Drug absorption in Peds
Increased absorption: Penecillins, Erythromycin
Decresased absorption: Acetopmenophen, Phenobarbital, Rifampin, Carbamezapine
Need HIGHER dosing in aminoglycosides
SCFE presentation
limited internal rotation of hip Presents with groin pain males 10-15, obese dx with XRay Tx surgical pinning
