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Peds Flashcards

1
Q

5 categories of things to cover in well-child visit

A 
vaccinations
growth
development
safety
abuse/neglect
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2
Q

evaluate growth at well-child visit

A

weight
height
head circumference

trend, if fall off growth curve, or in bottom 5th percentile, work up further
e.g. CF, heart disease, pyloric stenosis, GERD
malnutrition

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3
Q

in failure to thrive and malnutrition, which aspects of child growth suffer first?

A

1 weight
2 height
3 head circumference

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4
Q

well-child fell off growth curve into bottom 5%, what do you look for now

A

failure to thrive
(e.g. genetic (CF), heart disease, pyloric stenosis, GERD)
malnutrition
(formula, feed, frequency – do mom and dad know what they are doing? type, amount, freq?)

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5
Q

bare bones child development timeline

A

2mo - lift head, social smile
4mo - roll over
6mo - sit up, stranger danger (anxiety

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6
Q

bare bones child development timeline

A 
2mo - lift head, social smile
4mo - roll over
6mo - sit up, stranger danger (anxiety)
1y - walk, separation anxiety, 1 word
2y - stairs, 2 words
3y - tricycle, 3 words, circle
4y - hop, 4 words, cross
5y - skip, 5 words, triangle
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7
Q

bare bones motor milestones

2mo, 4mo, 6mo, 1y, 2y, 3y, 4y, 5y

A 
lift head
roll over
sit up
walk
stairs
tricycle circle
hop cross
skip triangle
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8
Q

bare bones social/language milesones

2mo, 4mo, 6mo, 1y, 2y, 3y, 4y, 5y

A 
social smile
-
stranger danger anxiety
separation anxiety 1 word
2 word sentences
3 word sentences
4 word sentences
5 word sentences
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9
Q

tf

you will die from a tetanus toxin dose lower than can be recognized by immune system

A

t

that is why we vaccinate w tetanus toxoid

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10
Q

when does maternal immunity typically wear off in a newborn

A

~6mos

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11
Q

reactions to watch out for when administering vaccines

A

made w egg CI egg allergy
-yellow fever vac
-some flu vacs but changing
x can now give MMRV

live attenuated CI immunocompromise aids chemo transplant biologics careful w pregnancy
-MMRV
-intranasal flu vac
x IM flu ok

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12
Q

MMRV vaccine stands for

A

measles
mumps
rubella
varicella

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13
Q

vaccs CI w egg allergy

A

yellow fever vac
some flu vacs but changing
MMRV ok now

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14
Q

vaccs CI w immunocompromise

A

live attenuated
-MMRV
-intranasal flu vac
IM flu ok

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15
Q

vaccine reactions considered normal

A

temp v104F (babies only?)
erythema
baby consolable

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16
Q

vaccine reactions considered abnormal

A

temp ^104F (babies only?)
anaphylaxis
baby inconsolable

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17
Q

normal vs abnormal vaccine rxns

A

temp v104 vs ^104
erythema vs anaphylaxis
consolable vs inconsolable baby

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18
Q

tf

acute illness is CI to vaccine

A

f

give vaccine

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19
Q

tf

family hx of abnormal rxn to vaccine is CI to vaccine

A

f

only personal hx of abnormal rxn to THAT specific vaccine

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20
Q

when does baby get Hep B vaccine

A

mom + baby hep b ivig and hep b vacc asap
mom - baby hep b vacc w/in 2mos
mom ? baby hep b vacc now, check mom’s HBsAg

so baby always gets hep b vaccine, but if mom negative can wait v2mos

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21
Q

what will hep b infection at birth from carrier mom mean for baby

A

chronic carrier state for baby

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22
Q

DTaP/TdaP vacc schedule

A

kids get 5 doses DTAP

  • 3 doses yr 1
  • 2 doses yrs 1-4

Td age 11 and q10y after or q5y if wound

23
Q

this bug causes epiglottitis

A

Hib

24
Q

tf

Hib exposure v2yo confers immunity

A

f

so give Hib vaccine

25
Q

tf

Hib vacc covers non-typeable Hib

A

f

26
Q

MMRV vacc demo

A

everyone vacc and booster before school

not for immunocompromised because live attenuated

27
Q

pneumococcal vacc demo

A

13 valent as infant

+ 23 valent if risk factors such as immunocompromise or asplenia

28
Q

meningococcal vacc demo

A

everyone should get it

espec close quarters dorms barracks

29
Q

HPV vacc demo

A

all boys and girls 9-26

30
Q

how many doses
hep A vacc
hep B vacc

and what to do if pt re-presents after falling off dosing schedule

A

2 for A
3 for B

pick up where you left off

31
Q

flu vacc demo

A

everyone unless CI

healthcare workers before winter mos

32
Q

what do cap vs lowercase letters mean in DTaP Tdap and Td ?

A

large dose vs small dose

33
Q

DTaP Tdap Td demos

A

DTaP x5 for kids
Tdap x 1 for all adults incl pregnant( every pregnancy!) and elderly… at least once age 11 and up
Td booster

34
Q

tetanus
ppx
dx
tx

A

DTaPx5 kids
Tdap x1 adults + Td booster q10y x2
tetanus ivig

dx clinically
puncture metal rust mud
lockjaw spastic paralysis

support intubate sedate muscle relaxants as needed to get through acute phase
-iv metronidazole

35
Q

tetanus
ppx
dx
tx

A

DTaPx5 kids
Tdap x1 adults + Td booster q10y x2
tetanus ivig

dx clinically
puncture metal rust mud saliva feces
lockjaw spastic paralysis

support intubate sedate muscle relaxants as needed to get through acute phase
-iv metronidazole

36
Q

treat wound for possible tetanus exposure

A

if v 3 lifetime doses (DTaP Tdap Td whatever)

  • Tdap if wound clean
  • Tdap + tetanus IVIG if wound dirty

if 3 or more lifetime doses

  • Tdap clean wound ^10y since last dose
  • Tdap dirty wound ^5y since last dose
  • send home if wound clean v10y since last; if wound dirty v5y since last
37
Q

tf

give tetanus ivig if last vaccine dose was ^5 years ago but 3 lifetime doses

A

f
no tet ivig if ^ 3 lifetime doses
only give tet ivig fewer than 3 lifetime doses and wound dirty

38
Q

diptheria
dx
tx

A

clinical dx fever, dysphagia, dyspnea, psudomembrane

inubate
antitoxin
ivabx

39
Q

phases of pertussis infection

A

I catarrhal = infectious, nonspecific symx
II paroxysmal = cough/woop
III resolution

40
Q

pertussis
dx
tx

A

clinical dx nonspecific infectious sympx, cough,woop, resolution

airway support, erythromycin
ppx w vaccine!

41
Q

tf

prefererred immunity to varicella is obtained at pox parties

A

f
used to play w chicken pox kid so everyone would get it

now MMRV preferred, prevent disfiguration, shingles later in life

42
Q

route of rotavirus vacc and CI

A

oral

intussusception CI

43
Q

mnemonic for whether LP is unsafe

A 
FAILS positive, increased icp
FND
AMS
Immunocompromised
Lesion
Seizure
44
Q

workup meningitis

A

FAILS positive
fnd ams immunocompromised lesion seizure
-blood cx, abx, ct, LP

FAILS negative
-LP, abx

45
Q

Meningitis
FAILS positive
Fnd ams immunocompromised lesion seizure

CT or abx first?

A

abx before CT – want patient to live through ct

Fails positive - blood cx, anx, ct, lp

46
Q

in peds meningitis, signs of ICP

A

bulging fontanelles

FAILS
fnd ams immunocompromised lesion seizure

47
Q

Tx meningitis in adult vs peds

A

Adult
Vanc
Ceftriaxone
Steroids (plus minus)

Newborn v30 days old
Vanc
Cefotaxime(ceftriaxone causes hyperbilirubinemia in newborns)
Ampicillin (Listeria coverage)
Steroids
48
Q

Meningitis with rash think this bug

A

Nisseria Meningitis

49
Q 
HIV baby
How does baby get it
How to prevent
How to diagnose
How to treat
A

Vertical transmission from Mom

  • HAART best case, mom knows and viral load is zero
  • AZT otherwise

PCR, skip ELIZA because baby v18mos not making their own antibodies yet, will just see mom’s

HAART FOR EVERYONE with HIV, including babies
Ppx cd4 (just know these, but cutoffs a little different in 6mos old)
v200 pcp - tmpsmx, dapsone, atovaquone
v100 toxo - tmpsmx, atovaquone
v50 mac - azythromycin

50
Q

Osteomyelitis in peds
Dx
Tx

A

Same as in adults
But if see salmonella, think sickle cell

If toxic, give abx then continue workup
If not toxic
-xr, bx, abx
-mri if xr neg

Abx course 4-6 wks
Most often STAPH AUREUS any age

51
Q

Most common bug in peds osteomyelitis

A

STAPH AUREUS most common in peds adults any age

If salmonella in kid think sickle cell

52
Q

TF

Bone scan to dx osteomyelitis

A

F
Tough to tell cellulitis from deeper infection on bone scan
Abx fast if toxic
If not toxic, xr, mri, bx in there

53
Q 
Septic joint in peds
Path
Pres
Dx
Tx
A

Ghonnorhea sexually active
teen
Staph aureus direct inoculation stab wound

Aspirate ^50,000 wbc

Abx

Peds (12 decks)

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