Peds Flashcards
12 Month Milestones
MOTOR: walks, throws objects
LANGUAGE: 1-3 words, follows 1-step command
SOCIAL: stranger and separation anxiety
4 Year Milestones
MOTOR: draw a cross, identify body parts, hops on one foot, throws overhand, copies a square (4.5)
LANGUAGE: language understood by strangers, uses past tense
SOCIAL: plays with other kids, social interaction
Imaging in hypertrophic pyloric stenosis
Thickened pyloric muscles via US
Upper GI w/Contrast may show elongated pyloric canal and a “double track” sign (two thin tracts of barium created by compressed pyloric mucosa)
Peritonsillar abscess
Infection of the superior pole of tonsils, most common in young teenagers. Presents with fever, sore throat, muffled voice, drooling, trismus, and neck pain.
May have deviation of uvula
1 Month Milestones
MOTOR: Reacts to pain
LANGUAGE: Responds to noise
SOCIAL: Regards human face, eye contact
Hypertrophic Pyloric Stenosis
Usually presents @ 3-6wk as “hungry baby” with projectile vomiting that is non bilious and occurs immediately after meals.
Physical exam will reveal olive shaped mass at RUQ and peristaltic waves across upper abdomen moments before emesis.
3-Year Milestones
MOTOR: copies a circle, pedals a tricycle, builds 3-block tower, repeats 3 numbers
LANGUAGE: speaks in sentences, 3/4 speech understood
SOCIAL: group play, plays games, knows gender, knows first and last name
2 Year Milestones
MOTOR: runs, walks up and down stairs, kicks a ball, copies a line
LANGUAGE: 2-3 word phrases, half of speech understood by strangers
SOCIAL: parallel play
Child lead screening?
All kids not previously enrolled in Medicaid should be screened @ 36-72mo
All children @ risk for exposure should be screened @ 1 yr
Intussusception
Telescoping of intestine → intermittent severe abdominal pain, associated vomiting that becomes bilous as obstruction occurs.
May get currant jelly stools and elongated mass palpable in right abdomen
Most common in ileocecal junction
4 Month Milestones
MOTOR: Eyes move past midline, rolls over
LANGUAGE: laughs and squeals
SOCIAL: regards hand
5 Year Milestones
MOTOR: copies a triangle, catches a ball, partially dresses self
LANGUAGE: writes name, counts 10 objects
2 Month Milestones
MOTOR: eyes follow object to midline, head up prone
LANGUAGE: Vocalizes
SOCIAL: social smile, recognizes parent
6 Year Milestones
MOTOR: skips with alternating legs, ties shoes, draws a person with 6 parts
LANGUAGE: identifies right from left leg
6 Month Milestones
MOTOR: sits unsupported, transfers object from hand to hand, and rolls prone to supine
LANGUAGE: babbles
SOCIAL: recognizes strangers
Retropharyngeal Abscess
Most common in kids 2-4 y/o via extension of pharyngeal infection, prenetrating trauma, iatrogenic instrumentation, or foreign body.
Will get fever, drooling, dysphagia, stridor, etc… May have tender enlarged cervical lymp nodes.
Young patient with 3-days of low grade fever and runny nose followed by erythematous rash on cheeks…cause?
Parvovirus → erythema infectiosum or “fifths disease”
Retropharyngeal abscess treatment
Cephalosporin
Antistaph penicillin
Conjunctivitis Treatment
Self limited in 10-14 days, can decrease to 2-3 days with sulfonamide given locally TID
What adolescents needs to see a cardiologist before getting cleared for their sports physical?
Any adolescent with the stigmata of Marfan syndrome, a murmur suggestive of HCM (heard along left sternal border that gets worse with standing or valsalva and improves with squatting), a grade 3/6 systolic murmur, or any diastolic murmur
9 Month Milestones
MOTOR: pincer grasp (10 mo), crawling, cruises (walks holding furniture)
LANGUAGE: “mama”, “dada”, “bye-bye”
SOCIAL: starts to explore
Peritonsillar abscess treatment
Ampcillin-sulbactam
or
clindamycin
Signs & Symptoms of Neonatal Sepsis
Temperature instability
Tachypnea, grunting, nasal flaring, retractions
Hypotension
Bradycardia
Overwhelming Shock → pallor & poor cap refill
Factors that increase risk of Early Onset GBS
- Ruptured membranes > 18hr prior to delivery
- Chorioamnionitis
- Intrapartum fever
- Previous infant with GBS
- Mom < 20 y/o
- Low birth weight or prematurity
Treatment for suspected neonatal GBS infection?
IV aminoglycosides (gentamicin, tobramycin) + Penicillin (ampicillin)
Osgood Schlatter Disease
Microfractures in the area of the insertion of the patellar tendon into the tibial tubercle, most common in athletic adolescents.
Get swelling, tenderness, and increase in size in the tibial tuberosity.
Orbital Cellulitis Treatment
Hospital admin w/CT or MRI to determine extent of infection
IV abx
Complications of orbital cellulitis in children
Cavernous sinus thrombosis
Meningitis
Brain abscess
Vision loss from increased intraorbital pressure w/retinal artery occlusion
Febrile, ill-appearing child with proptosis and restriction of eye movement
Orbital cellulitis
5 year old boy with itchy rash that was on his face as an infant but as he got older moved to his flexural areas. Rash is worse during winter.
Rash is maculopapular, red, and weepy.
Eczema
Initial Presentation = papulovesicular, weeping eruption that progresses to a scaly, lichenified dermatitis
From 3 mo-2 yr typical on cheeks, wrists, scalp, arms, and legs.
From 2-12 yr moves to mostly extensor surfaces
Presentation of head lice
Intensely itchy scalp that can be weepy, boggy, and red.
May also get swollen posterior auricular and suboccipital LN
Head Lice Treatment
Children > 6 mo: Topical ivermectin
Rid & Nix (OTC) often have resistance
Tuberculous Meningitis
Most common between 6 mo-4 yrs
Stage 1 = 1-2 wk of non-specific symptoms such as vomiting, irritability, listlessness, fever, regression of milestones, etc…
Stage 2 = begins abruptly with seizures, lethargy, hypertonicity, hydrocephalus, and focal neurologic signs
Stage 3 = coma, HTN, posturing, decompensation, & death
Leukocyte Adhesion Deficiency Type 1 (LAD-1)
Intact umbilical cord after 1 month
Overwhelming bacterial infections
CBC will show leukocytosis; can make diagnosis by measuring CD11b using flow cytometry
Screening for lead poisoning
Blood Lead Level, preferably venous
Toxicity can occur at levels as low as 10ug/dL and EPO may not be elevated in such low-level poisonings
Fragile X Syndrome Characteristics
Macrocephaly w/long face, large ears, & prominent jaw
High arched palate
Evidence of mitral valve prolapse
Macroorchidism
Pectus excavatum
Repetitive speech, gaze avoidance, and hand flapping
1-wk old infant with transient rash = splotchy areas of erythema with a central pustule whose fluids reveal eosinophils
Erythema toxicum
2-3cm erythematous macules, occasionally with central yellow-white pustule
Adolescent boy with 3-5cm red rash at nape of neck that gets more significant with exertion or emotion
“Salmon patch”
Aka: nevus simplex or nevus flammeus
Vascular lesions that occur on face, nuchal, and occipital regions
3-day old African-American boy with 3mm pustules filled with milky fluid that are easily wiped away to reveal an underlying small hyper-pigmented macule
Pustular Melanosis
More common if African-Americans
Usually found at birth and consistent of 1-2mm pustules → hyperpigmented lesion encircled by scale after they rupture.
1-day old with a 0.5cm oval lesion on the righ occiput that is yellowish and slighly raised, hairless, and “orange-peel” in texture.
Sebaceous nevi = small sharply edged lesions on head and neck of infants.
Can get malignant degernation after adolescence
