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Clinical Medicine > Peds > Flashcards

Peds Flashcards

1
Q

what is the CDC’s reccomendation on which growth chart to use

A

WHO growth charts up to 2

CDC/NCHS from 2-19

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2
Q

four growth parameters to measure

A

head circumference

length

weight

BMI

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3
Q

what is OFC in regards to pediatric growth measurements

what is the concern if it is large

what is the concern if it is small

A

occipital-frontal circumference

hydrocephalus

poss poor brain development

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4
Q

when is the period of most rapid head growth

A

0-2 months

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5
Q

what are the two main periods of increasing length

A

infant and adolescence

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6
Q

how much does length increase in the first year

by four years

by 13years

on average how much does high increase between age 2 and teenage years

A

50%

2x

3x

2” per year

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7
Q

how to estimate adult heigh based on height at age 2

A

take the height and double it

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8
Q

estimate adult height based on parents height for boys

girls

A

boys: Mom height + 13 + Dad height/2 +-5
girls: mom height + dad height - 13/2 +-5

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9
Q

T/F childten may up to 10% of their birth weight

what would you expect to happen at week 2

A

true

they shuld have gained their weight back

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10
Q

how much weight should a baby gain

A

15-30 (.5-1 oz) everyday

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11
Q

how long should a baby get back to birth weight after birth

when should they have doubled their weight

tripled

quadrupled

A

2 weeks

4 months

1 year

2 years

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12
Q

how much weight should a child gain between age 2 and adolescence

A

5lbs

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13
Q

calculating ideal birth weight for men

for women

what are the flaws

A

110 for 5’ then 5 lbs every inch

100 for 5’ then 5lbs for every inch

only works for people >5ft tall, estimates too low for women, usually for calculating doses and assessing severity of anorexia

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14
Q

T/F gross motor development progresses from the bottom up

A

false, it progresses from the head down

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15
Q

what is the rationale for using the WHO growth charts until age 2 then the CDC charts after

A

breastfed infants regardless of background are generally the same

after age 2 the diet and health care availible in the US will cause us to have larger children

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16
Q

differentiate length vs height

A

length is laying down

height it standing

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17
Q

where do boys hit their highest growth velocity

girls

what accounts for this difference

A

14

12

girls growth plates fuse faster during their growth spurt, boys stay open longer and allow for more gradual growth before the growth spurt

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18
Q

why add 13 or minus 13 from the parental heights when calculating height

A

it takes into account the genetic potential the mother had or the growth the father experienced before the growth spurt

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19
Q

12 month old presents with mom for Well Child Visit.
Mom concerned that baby is smaller than his 9 month old cousin.
Mom is worried she is not feeding him well enough. He drinks 30 ounces of whole milk per day with 3 meals and 3 snacks.

Mom’s height: 5’2 (157cm)
She is the tallest girl in her family, but the men in her family are close to 6 foot tall
Dad’s height: 5’4” (162cm)
He has siblings that are shorter than him

should they be concerned

A

no, there is a strong possiblity based on CDC charts that the child will just be short

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20
Q

BMI standard for peds

A

underweight <5%

healthy 5-84%

overweight 85-94%

obese >95%

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21
Q

what is more important for pediatric growth before 4 years, TH or GH

after 4

A

TH before 4, GH after 4

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22
Q

when should head leg go away in an infant

A

between two months and 6 months they should have the strength and recognition to tuck their chin

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23
Q

categorize these from top to bottom

A

1 month no head up

2 months about 45 deg

4 months head up and rolling

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24
Q

how do most kids learn to roll over

A

front to back accidently as they look around and fall over

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25
Q

gross motor development milestones

rolling

sitting

crawling

A

4 months

6 months

9 months

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26
Q

gross motor development milestones

cruising

walking

walking backward

running

A

10-11 months

12 months

15 months

18 months

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27
Q

gross motor development milestones

running

jumping & climbing stairs (2 feet)

tricycle & climbing stairs (alternating feet)

A

18 months

2 years

3 years

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28
Q

gross motor development milestones

hops on 1 foot, go down stairs alternating feet

jumps over things

A

4 years

5 years

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29
Q

fine motor development milestones

2 months

3 months

4 months

A

follow past midline

follow 180 deg

reach with two hands

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30
Q

fine motor development milestones

6 months

9 months

12 months

A

transfer object and raking

immature pincher

matuer pincer

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31
Q

describe the evolution in fine motor skills in terms of grasping

A

6 months they should rake

9 months they should do an inferior pincher grasp

12 months the should do a fine pincher grasp

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32
Q

describe these from top to bottom

A

rake, thumbs aducted, proximal and distal thumb joints flexed, happens at 6 months

inferior grasp between the thumb and the index finger beginning opposition, 9 months

fine pincher between fingertips, 12 months

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33
Q

fine motor milestones

15-18 months

A

use a spoon and cup

2 block tower

scribbles

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34
Q

fine motor milestones

2 years

3

4

A

6 block tower

draw circle, clothes off

draw a cross

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35
Q

fine motor milestones

4.5

5

A

draw square, clothes on, buttons, catch ball

tie shoes

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36
Q

language development milestones

2 months

4 months

6 months

A

smile

laugh

babble

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37
Q

language development milestones

9 months

12 months

15 months

A

wave bye

jargoning (intonation), performing 1 step commands with gesture

1 step commands

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38
Q

language development milestones

18 months

2 years

A

know 5 body parts

2 word sentances, “what”, 50 word vocab

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39
Q

language development milestones

3 years

4 years

5 years

A

3 word sentances, why, temporal orientation, 250 words

4 colors, songs or poems from memory

print first name

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40
Q

describe 2/4, 3/4, 4/4 as it relates to language development

A

2 yeasr should be 50% intelligible language

3 years is 75%

4 years is 100% intelligible

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41
Q

social development milestones

1

2

6 months

A

regards face

recognize parents

likes looking around

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42
Q

social development milestones

6

8

12 months

A

strangers

expoloring+pat a cake

imitation, comes when called

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43
Q

social development milestones

15-18 months

A

independent

copies parents (18months)

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44
Q

protoIMPERATIVE vs protoDECLARATIVE

A

at 15 months they can’t speak but they can point to what they want (imperitive)

18 months can point something out as interesting (declaritive)

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45
Q

when is autism evident in toddlers

A

15-18 months, they can’t speak but they can interact by pointing and should want to do that

may also point with a thumb instead of forefinger

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46
Q

social development milestones

2

3

4 years

A

parallel play

group play, sharing, taking turns

associate gender specific categories, competition

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47
Q

why is sharing difficult to learn at age 3

A

because children lack empathy to understand that not everything is theirs

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48
Q

when is a newborn hearing screen done

when should it be repeated

when should signs of hearing loss be assessed

A

at discharge

at age 4

with each visit

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49
Q

signs that infants can hear

at 0-2 months

A

startle response and blink to sudden noise

calming down with soothing voice or music

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50
Q

signs that infants can hear

2-3 months

A

change in body movements in response to sound

change in facial expression to familiar sounds

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51
Q

signs that infants can hear

3-4 months

A

turning eyes and head to sound

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52
Q

signs that infants can hear

6-7 months

A

turning to listen to voices and conversation

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53
Q

around when will children begin to show imagination

A

3-5 years

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54
Q

incidence in hearing loss in babies

when is intervention most crucial

A

2-4 out of 1000 babies

intervention is critical before 6 years

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55
Q

T/F babies have excellent vision

A

false, very poor 20/400 in black and white with a fixed focal length of 12 inches

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56
Q

when do infants develop full color vision

A

7 months

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57
Q

goals of a well child check

A

assess growth and development

identify problems to provide education and early intervention

teach parents childcare and parent care

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58
Q

describe these pictures in terms of infant development

A

at four months a baby will lay on its back and grasp something at th midline

at 6 months a baby can sit up, listen, see, hear

at 1 year they can stand, talk, and pincer grasp

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59
Q

6 topics for a well child visit

A
  1. Interval history since last appointment
  2. Parent concerns
  3. Child care
  4. Review medical history
  5. Review medications / allergies
  6. Sleep issues
  7. Dietary issues
  8. Family risk factors
  9. Nutrition evaluation
  10. Anticipatory guidance (aka stuff you teach the parents)
  11. Immunizations
  12. Screening labs if indicated
  13. Developmental and Mental Health
  14. Fine motor / Gross motor
  15. Hearing
  16. Vision
  17. Dental
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60
Q

pateitn presents tolerating solid food, brings feet to her mouth, being distracted by a mirror and pats her image

which of the following developmental milestones are most typical for in infant whose age is what

A) 2 months

B) 4

C) 6

D) 9

E) 12

A

c, 6 months. tolerating solid food, placing feet in mouth, and reaching for a mirror while patting the image are all typical 6 onths milestones

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61
Q

6 month old girl presents with mom for Well Child Visit.
Mom states that baby is eating well.
Baby has social smile and is cooing.
On physical exam baby has head lag. Not able to push up on hands. Has not started rolling over yet. Can not keep head steady when held in sitting position.
Growth chart demonstrates less than optimal growth

why might this be considered normal

A

if the baby is premature, comparisions to growth and development are made to their gestational age until2 years

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62
Q

baby presents saying hi to receptionist, asking for juice, tries to give her doll a drink, knows her mouth, imitates mother, and knows mama

what age would you expect this child to be

A

18 months

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63
Q

patient presents able tos tand, take a few steps independently, and uses a two finger grasp

what age would you expect this patient to be

A

12 months

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64
Q

what is preferred method of infant nutrition

A

breast feeding up to 6 months, try to main tain for 12 months

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65
Q

when is formula used

A

if breastfeeding isn’t possible or desired

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66
Q

two contraindications for breastfeeding

A

infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency)

mother who have HIV

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67
Q

how often should a baby be breastfed

A

8-12 x in 24 hours in the first month

7-9x 1-2 months

6-8x 2-12 months

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68
Q

how do you know if a baby is breastfeeding well

A

are they gaining weight

content/active/alert

wet or dirty diapers regularly

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69
Q

how much formula should be given when using formula

A

2-2.5 oz per lbs in 24 hours

2-3 oz ever 3 hours

4-6 every 3-4 hours

max 32oz at 24 hours before eating solid foods

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70
Q

when should babies be tranisitioned to solid food

indications a child is ready for solids

A

4-6 months

does the baby hold up their head, open their mouth at the sight of food, at least double their body weight from birth

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71
Q

reccomdations for infant cereal

baby food

A

start with 1-2 teaspons of a single grain cereal mixed with breast milk, formula, or water, then advance to 1-2 table spoons twice daily

give a new food each day, start with 1 tsp working up to a full jar

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72
Q

when should a baby start eating finger foods

A

7-8 months, or when they can sit up and bring objects to their mouth

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73
Q

how long should fruit juice be withheld

whats the maximum amount of fruit juice

should it be put into a bottle

A

1 year

4oz/day max up to half the daily reccs for fruit

no, only from a cup

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74
Q

reasons parents should avoid juice

A

cavities

malnutrition

short stature

perioral rash

diarrhea

GI symptoms

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75
Q

when should the transition to cup and utensil feeding happen

A

as soon as possible

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76
Q

when should toddlers transition from breast milk/whole mile to low fat milk

A

2

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77
Q

T/F abnormal flucuations in appetite are abnormal

A

false, they are normal and should be expected

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78
Q

why can iron and zinc defiency be an issue in pediatrics

A

because meat is a major source of both and kids don’t necessarily like the taste/texture of them

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79
Q

T/F parents should fed children snack food if they won’t eat normal food

A

false, don’t let them eat food with no nutritional value just to get them calories

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80
Q

what is the calorie need of toddlers

how much of that is fat

A

1000, half from fat

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81
Q

why is fiber very important for toddler nutrition

A

prevention of constipation

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82
Q

questions to ask during a nutritional interview

A

who buys and makes food

who does feedings

are they on a consistent schedule

aer you offering good portions

do you eat out

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83
Q

key issues for school aged nutrition

A

getting enough fruit, veggies, calcium, vit d

avoiding junk food

developing a healthy body image

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84
Q

guidlines for school aged nutrition

A

consume 3 meals with 2-3 snacks as dicated by appetite, growth, activity

limit grazing

avoid automatic eating

avoid junk food

favor fresh foods

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85
Q

big change between school age kids vs toddlers

A

decrease from 50 to 35% total cals from fat

45-65% carbs less than 10% simple sugar

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86
Q

causes of pediatric malnutrition

A

inadequate intake from eating disorders or limited access

celiac disease

crohns

chonic liver disease

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87
Q

conditions sequelae to pediatric malnutrition

A

illness

stunted growth

hyperactivity

aggression

anxiety

mental disabilities

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88
Q

pellegra

risk factor

solution

A

a niacin deficiency

maize based diet

foods rich in protein and whole grains

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89
Q

beri-beri

risks

solution

A

thiamin deficiency

polished rice or other cereal diet

whole or parboiled rice, legumes, protein sources

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90
Q

what nutritional factor will cause a vitamin A deficiency

how can it be resolved

A

a diet without enough fresh fruit

dark orange fuirt and veggies, yellow corn, dark green veggies

91
Q

scurvy

risks

solution

A

vitamin C defiency

diet without fresh fruit and a low fat intake

more fruit, veggies, liver, animal milk

92
Q

T/F you can have an obese child who is malnourished

A

true

93
Q

failure to thrive

A

decline in weight curse by two percentile channels from a previously established rate

94
Q

typical pattern for failure to thrive

A

decreased weight with normal height and head circumference, progressing to height and head slowing

95
Q

treatment for failure to thrive

A

correct underlying cause (usualyl inadequate intake)

look at social environment for poor eating or learned behavior

96
Q

BMI in pediatrics is based on the number or their percentile

A

percentile

97
Q

what demographics are most likely to be obese

A

hispanic boys and black females

98
Q

potential complications of childhood obesity

A

HTN

dyslipidemia

DMII

sleep apnea

mental health problems

orthro issue

99
Q

what is the probability that pediatric obestity will progress into adulthood

A

20% at 4 years

80% at adolescence

100
Q

risk factors for childhood obesity

A

genetics

behaviors

environment

101
Q

two ways to gather infromation that will help early recognition of high-risk patterns of weight gain

A

dietary history

activity log

102
Q

measurements and observations to help dectect pediatric obesity

A

plot trend on ht, wt, bmi

blood pressure

note on adiposity

labs

103
Q

what is acnthosis nigricans indicative of

A

high levels of insulin

104
Q

lab tests for obese childten based on BMI 84-94th percentile with and without risk factors (FHx, HTN, high lipd levels, tobacco)

what if BMI is +95th

A

fasting lipids

fasting lipids with AST, ALT, fasting glucose

same as the ones with risk factors

105
Q

treatment for childhood obesity

A

eat less do more

106
Q

staged approach to treating obesity

A

prevention plus

structured weight management

comprehensive multidisciplinary

tertiary care intervention

107
Q

differentiate between stages of obesity treatment (prevention plus, structured management, comprehensive multidisciplinary, tertiary care)

A

counselling with emphasis on lifestyle changes

meal planning, exercise, behavior goals with dietician or therapist

multidisciplinary team with weekly meetings

mutlidisciplinary team that might involve medications or surgery

108
Q

what is the maximum amount of weight loss reccomended for BMI over 95th percentile before age 11

A

lose 1 lb per month

109
Q

pharmacotherapy treatment for obese children

A

orlistat (lipase inhibitor) approved for >12 yrs old

110
Q

AAP reccomendation for TV

A

no tv before 2, max 2 hrs after 2

111
Q

indications for bariatric surgery of obesity

A

severely obese adolscents who are mature with a BMI over 50 or over 40 with comorbid conditions

AND

failed a structured weight loss program for six months

AND

are psychologically ready for major lifestyle changes

112
Q

contributing factors of teenage smoking

A

low SSE

use or approval from peers/siblings/parents

availabilty and price

no parental support

low self esteem

113
Q

5 A’s for smoking cessation

A

ask

advise

assess

assist

arrange

114
Q

three parts of pubertal cognitive development

A

change in secondary sex characteristics and development of reproductive ability

cognitive recognition of the previous

moral determination of right and wrong in shade of grey

115
Q

progression of cognitive ability associated with adolescents

A

formal operational thought (development of logic, deduction, planning)

use of abstract thought to consider possible outcomes and consequences

increased self awareness

116
Q

PSYCH primary care providers screen for socio-emotional problems

A

Parent child interaction: how are things going with your parents

school: how are things in school
youth: how are things with friends
casa: how are things at home
happiness: how would you describe your modd

117
Q

what demographics have increased risk of depression

A

teenage girls and minorities

118
Q

pharmacotheraputic treatment of depression in adolescents

A

SSRIs are useful and 30% of patients don’t remit after initial treatment

second and third line treatments are available

third line treatment should involve referral

119
Q

how long should depression be treated with SSRIs

why is it important to have adherence

A

6-12 months

relapse is more common with patients who stop taking drugs once symptoms remit

120
Q

why would SSRI treatment be considered for longer than 6-12 months

A

if the depression episode includes psychosis, suicidal behavior or ideation, functional impairment, resistance to treatment, previous failure to reduce medication

121
Q

what is the leading cause of morbidity/mortality in adolescents

A

MVA, frequently involving alcohol or texting

122
Q

possible explanations why suicide rates are increasing

A

increased drug and alcohol abuse

depression

family/social disorganization

access to firearms

social media

123
Q

what is the lag time in SSRI treatment

A

4-6 weeks before there is an appreciable effect

124
Q

T/F there is no evidence that screening for suicidal ideation in teens reduces suicides

A

true, suicidal patterns can be identified but there is little effect on outcomes

125
Q

general screening questions for suicide

A

depression

substance abuse

hx of violence, victimization, or witnessing violence

126
Q

Suicide-Screening Questionare questions

A
  • In the past few weeks, have you wished you were dead?
  • In the past few weeks, have you felt that you or your family would be better off if you were dead?
  • In the past week, have you been having thoughts about killing yourself?
  • Have you ever tried to kill yourself?
127
Q

questions to ask if you think there is a suicide risk

A

content, nature, chronicity of thoughts

planning

details of the plan

128
Q

once suicidal ideation with planning has been identified what is the goal

A

work with family to address safety issues

removing access to means

constant monitoring

129
Q

when would you put a patient on a 24 hour hold

when would you refer to psych

A

if there is imminent risk of suicide

if there is a plan but not imminent risk of suicide

130
Q

lab tests for suicide attempts

A

toxicology screen

pregnancy test

drug and alcohol screen

test for medical conditions that can lead to psychiatric disorders (thyroid, SLE, IBS)

131
Q

what is the standard of care for suicide attempts

other options?

A

hospitalization, though it is not proven to prevent future suicide

outpatient treatment for low risk pts with intensive home therapy

132
Q

pharmacotherapy for suicide

A

no proven treatment, SSRIs might be used during initial therapy or if underlying psych disorders are present

133
Q

what can we do to prevent suicide

A

recognize disrders

screen

anticipatory guidance on drug use, firearms etc

be tehre

reduce stigma of mental healt conditions

134
Q

T/F school and community based suicide prevention programs are effective

A

false, there is some evidence for school based support

135
Q

what percent of high school students exercise for 60 minutes daily

A

35%

136
Q

what makes breast milk superior nutritionally to formula

A

contains a species specific amount of fat, sugar, and minerals

antibodies

changes to adapt to what the baby needs

137
Q

how many women start breast feeding

how many continue breast feeding until 6 months

A

81%

50%

138
Q

short term maternal benefits of breastfeeding

A

less postpartum bleeding

easier postpartum weight loss

delays ovulation

allows for mother/infant bonding

139
Q

long term maternal benefits of breastfeeding

A

reduced risk of breast and ovarian cancer

decreased risk of CV disease, HTN, hyperlipidemia

decreased risk of DM II

140
Q

infant benefits of breast feeding

A

decreased rate of ear infections, respiratory illness, allergies, diarrhea, childhood obesity, SIDS

141
Q

what is the economic benefit of breast feeding

A

saves $1200/yr on formula

lower healthcare issues due to fewer illnesses

142
Q

the five steps of lactation physiology

A

mammaogenesis

lactogenesis

galactokinesis

galactopoiesis

involution

143
Q

mammogenesis

A

development of breasts to a functional state

144
Q

lactogenesis

stages

A

synthesis and secretion of milk from the breast alveoli

Stage I: colosutrum production starting at week 16

Stage II: sharp increase in production due to decreased progesterone after delivery of the placenta

145
Q

galactokinesis

galactopoiesis

A

ejection of milk

maintenance of lactation

146
Q

involution

A

regression and atrophy post lactation

147
Q

types of breast milk

A

colostrum: late pregnancy until 4 days after delivery (antibodies)

transitional milk: day 4-10, lower in protein than colostrum

mature: produced from day 1o through completion of breastfeeding

148
Q

describe the positive feedback mechanism that regulates milk production

A

sensory stimulus of suckling triggers a release of prolaction from the anterior pituitary and oxytocin from the posterior pituitary

149
Q

function of prolactin in breastfeeding

oxytocin

A

increases milk production

stimulates let down from the breast

150
Q

why is breastfeeding preventative for uterine bleeding postpartum

A

it causes smooth muscle contraction and involution of the uterus

151
Q

T/F the decrease in ovulation from breastfeeding can be considered contraceptive

A

false, there is still a change to get pregnant

152
Q

what is the best way to maximize milk production

A

infant feeding or pumping (not as effective)

153
Q

do exercise or contraception have an effect on lactation

A

little if any

154
Q

ways to decrease milk production

A

stress (inhibits milk let down)

smoking

supplementation with formula

engorgment

155
Q

signs of hunger to indicate breastfeeding should start

A

increased alertness

mouthing or rooting

bringing hands to mouth

crying is the last one

156
Q

signs of satiety after breast feeding

A

relaxation of arms and elgs

eyes close

falling asleep

157
Q

T/F breast milk is lacking in vitamin D

A

true

158
Q

tips on how to initiate a latch

A

bring baby to breast

infant facing mother

wide gape for nipple and areola

lower lip out

full cheeks

tongue extended

159
Q

typical breastfeeding schedule during the first week

A

wake every four hours to feed

follow urine and stool

160
Q

common issues with breast feeding

A

inadequate milk supply (most common reason for termination)

nipple or breast pain

breast infections (mastitis/yeast)

maternal medication use

161
Q

special psych risk for post partum women who are having difficulty breast feeding

A

postpartum depression

162
Q

reasons for inadequate milk production

A

insufficient breast development (rare)

previous breast surgery (augmentation or reduction)

delay in progression to stage II lactogenesis

maternal drugs that decrease milk production

163
Q

issues with breast reduction that can decrease milk production

A

interruption of ducts

decreased blood flow

nerve damage that decreases reflex arc

164
Q

factors that can delay progression to stage II lactogenesis

A

materanl pre-pregnancy obesity

gestational hyertension/preeclampsia

PCOS

retained placenta fragments

pituitary insufficiency (sheehans syndrome)

165
Q

drugs that can decrease milk production

A

decongestants, antihistamines

166
Q

problems that can least to milk extraction issues

A

insufficient nursing and poor feeding schedule

problems with latch

ankyloglossia

167
Q

ankyloglossia

A

baby born with a short frenulum that limits tongue extension

168
Q

when should you be concerned a baby was not getting fed enough

A

weight loss beyond 3 days of life

weight loss of >7% of birth weight

failure to regain birthweight by day 10 of life

169
Q

sheehands syndrome

A

a loss of pituitary function from episodes of extremely high blood pressure

170
Q

Risks of insufficent feeding

A

dehydration

elevated bilirubin

re-hospitalizxation

acute renal failure -> shock, sz

171
Q

when should supplemental feeding be considered

A

dehydration

<3 stools/day

loss of 7% birth weight

limited maternal milk supply

172
Q

galactogogues

two types

A

medications that can increase milk supply

reglan, fenugreek

173
Q

what is the dosing schedule for reglan for breastmilk production

is it proven successful

how long should the course be

A

10mg/8hrs

limited evidence, some anecdotal

limit to 1-3 weeks unless it works really wel

174
Q

what is the issue with fenugreek supplmentation for breast feeding

A

it can help increase production but it isn’t welll proven

175
Q

causes of nipple and breast pain

A

breast pump use

nipple vasoconstriction from reynauds

engorgment

plugged duct

nipple issues

176
Q

how to treat reynauds associated with breastfeeding

A

warm the whole body

177
Q

treatment for engorgement related to breast feeding

A

empty breast, pump if needed, check latch, take nsaids

178
Q

treatment for a plugged duct related to breastfeeding

A

check latch

warm compress

expression

analgesics

179
Q

nupple issues with breastfeeding

A

nipple or breast infections

dermatitis or psoriasis

inverted nipples

180
Q

overall management of breast and nipple pain from breast feeding

A

get a good latch

be aware that is is normal

nurse on the unaffected side first

avoid excess moisture/air dry

181
Q

masitis

incidence

causes

organism

A

local inflammation of the breast that causes fever, myalgia, pain, firmness

5-10%

ineffective feeding/incomplete emptying, plugged ducts, nipple damage

usually from staph

182
Q

treatment of mastitis

A

nsaids, cold compressess

continue breast feeding

ABx

183
Q

treatment of non-severe, low risk MRSA mastitis

A

dicloxacillin

keflex

clindamycin

184
Q

treatment of non-severe, moderate MRSA mastitis

A

trimetoprim-sulfamethoxazole

clindamycin

185
Q

treatment of severe mastitis

A

inpatient IV vancomycin

186
Q

what usually preceeds a breast abscess

symptoms

evaluation

treatment

A

usually preceded by mastitis

breast pain, fever, myalgias, fluctuant, tender mass

evaluate by ultrasound, treat with I&D

187
Q

symptoms of yeast infection in the breast

A

pain out of proportion with findings on exam

history of infant oral or diaper candidal infection

maternal vaginal yeast

shiny, flaky nipple skin

188
Q

treatment of nipple yeat infections

A

topical antifungal

combination of antifungal

gentian violet

maternal fluconazole

infant nystatin

189
Q

contraindications of breastfeeding

A

infant with galactosemia

HIV+

human T cell lymphotrophic virus

active TB

cytotoxic chemo

illicit drugs/alcohol

190
Q

galactosemia

symptoms

A

inborn error of metablism that leads to accumulation of galactose

failure to thrive, liver dysfunction, mental retardation

191
Q

reccomendations for HIV breastfeeding

A

formula in developed countries

breastfeeding in poor countries

192
Q

common diseases that are NOT contraindications for breastfeeding

A

HepB (if the infant is immunized at delivery)

HepC

maternal fever

chorioamnioitis

materanl CMV if the baby is term and mother hasnt converted

193
Q

indications to pump and bottle feed

A

materanl varicella, occuring 5 days before throigh 2 days after

active herpes on the nipple

active H1N1 flue

194
Q

what is the best way to support breastfeeding after birth

A

skin to skin contact increases breastfeeding by 42.6 days

195
Q

barriers to breastfeeding

A

african americans

adolescent, <25 years

single mothers

smokers

less than high school education

participation in WIC

early return to work

unwatnted pregnancy

196
Q

when is it ok the start breastfeeding after general anesthesia

A

when the mother is alert

197
Q

how long after drinking should breastfeeding be allowed

A

2 hours after a single drink

198
Q

what is fetal alcohol specturm disorder

A

the rangle of effects that can occur in an individual who is exposd to alcohol during the nine month prenatal period before birth

199
Q

common features of fetal alcohol syndrome

A

craniofacial dysmortpholgy

growth deficits

neurological abnormalities or deficits

200
Q

T/F prenatal alcohol is the leading cause of birth defects and development disabilities

T/F alcohol causes worse neurobehavioral effects than other drugs

A

true to both

201
Q

fetal alcohol syndrome

A

mental, physiolofgical, neurological, and behavior birth defects caused solely by expsoure to alcohol during pregnancy

202
Q

T/F animal studies show that continous drinking is more damaging than binge drinking

A

false, other way around

203
Q

pathophysiology of FASD

A

alcohol quickly crosses the placenta

the fetal liver lacks alcohol dehydrogenase or gluthiaone to break down alcohol

amniotic sac holds alcohol

204
Q

what are the effects of ethanol/acetaldehyde in FASD

A

disrupt cell differentiation

DNA and protein synthesis

inhibition of cell migration

altered fat/protein/carb metabolism

decrease movement of amino acids, protein, folic acid, minerals across the placenta

205
Q

CDC criteria for diagnosis of FAS.

how amany are needed for diagnosis

A

facial dysmorphia

growth deficits

CNS abnormalities or behavior deficits

all three

206
Q

facial dysmorphia related to FAS

A

smooth philitrum

thin vermilion border

small palpebral fissures

micrognathia

epicanthal folds

minor ear abnormalities

207
Q

growth deficits related to FAS

A

prenatal or post natal and or weight below 10th percetile at one point in time adjusted for age, sex, race

208
Q

CNS or neurobehavior deficits related to FAS

A

head circumference below 10th percentile

clinically significant brain abnormalities observed through imaging

abnormalities in function skills of the CNS

209
Q

T/F you have to have confirmed prenatal alcohol use to make a diagnosis of FAS

A

false

210
Q

abnormalities of functional skills of the CNS related to FAS

A

decreased cognition

motor delays

ADHD

social skill issues

language problems

others

211
Q

clinically significant brain abnormalities associated with FAS

A

changes in the corpus callosum, cerebellum, basal ganglia

212
Q

cognitive difficulties for a person with FASD

A

taking and retaining infrmation (sensory integration)

recollection

using informaiton in a specific situation

213
Q

primary disabilities related to FASD

A

lower IQ

impaired abilites in reading or math

lower level of adaptive functioning

commonly diagnosed with ADHD

214
Q

sensory integration issues with FASD

strategies to overcome

A

overly sensitive to stimulus, problems with kinesthetic awareness, loss of social cue recogition

simplifiy environment, take steps to avoid sensory triggers, OT/PT interventions

215
Q

memory issues with FASD

A

information recall (learning, test taking, directions)

putting things from memory in sequential order

216
Q

strategies to avoid memory issues associated with FASD

A

provide direction one rule at time

review rules regularly

repetition

217
Q

typically difficulties with information processing with FASD

A

may feign understanding

poor judgement in decision making

don’t ask questions because they want to fit in

218
Q

examples of executive functioning issues associated with FASD

A

repeatedly break rules

doesn’t learn from mistakes

issues with time and money

susceptible to peer pressure

219
Q

stragegies to deal with executive functioning in FASD

A

use short term consequences

establish achievable goals

provide skill training that uses role play

220
Q

secondary disabilities associated with FAS/FASD

A

mental health issues

school issues

trouble with the law

inappropriate sexual behavior

substance abuse

221
Q

preventing secondary disabilities associated woith FAS/FASD

A

get early diagnosis and help

family education

increase supervision in adolescence and early adulthood

proactive adult support and mental health services

222
Q

myths about alcohol and FASD

A

less than one drink a day is ok

drinking late in pregnancy is ok

drinking is good for breastfeeding

the health benefits of red wine make it ok

FASD is curable

223
Q

T/F studies show that low to moderate drinking does not cause FAS/FASD

A

true, but many disorders might not be come evident until after age 5

Clinical Medicine (11 decks)

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