Peds

Question 1

Pharmacodynamics

Answer 1

knows no age. The way a medication works in an infant is the same way it works in an older adult.

Question 2

Pharmacokinetics

Answer 2

Pharmacokinetics vary over the lifespan, with most healthy children being in effective drug biotransformers and eliminators

Changes through the lifespan

Question 3

Defining times of early childhood

Answer 3

Neonate - 0-28 days
Infancy the first year of life
Toddler ages 1 to 2 years
Preschool ages 3 to 4 years
School aged ages 5 to 12 years

Question 4

Term

Answer 4

37 weeks = early term
40 weeks = term
41 weeks = late term
42 weeks= post term

Remember: Adjusted age for preterm infants*

Question 5

Positional plagiocephaly

Answer 5

Alternation of shape of the skull due to position.

Tummy time important to avoid

Treatment helmet

Question 6

Proper latch in breastfeeding

Answer 6

During breast-feeding with proper latch, no dimpling other babies cheeks, no clicking sound with sucking.

The cheeks should be round, and the nose should be on the breast.

Question 7

Physiological jaundice

Answer 7

Any jaundice after the first 24 hours of birth

Any jaundice before the first 24 hours of birth is almost always pathologic.

Encourage breast-feeding at minimum every 2 to 3 hours while avoiding dextrose in water feelings will help minimize the newborns risk of hyperbilirubemia

Question 8

Chlamydial conjunctivitis

Answer 8

Signs and symptoms present between 5 to 14 days post exposure

examination will reveal bilateral eyelid swelling conjunctival edema and Mucoid discharge.

Ocular erythromycin at birth would minimize the risk of gonococcal conjunctivitis but not chlamydial conjunctivitis.

Treatment: IV or IM ceftriaxone and oral erythromycin for two weeks also protects the respiratory track risk of pneumonia.

Coinfection with gonoccoal common

Question 9

Moro reflex

Answer 9

Aka startle reflex

Throwing out arms and legs followed by pulling them back to the body following a sudden movement or loud noise.

No longer seen by 4 months

Question 10

Palmer grasp

Answer 10

Grasping at Object when placed in the palm.

No longer seen by 2 to 3 months.

Question 11

Babinski reflex

Answer 11

Stroking the soul of the foot elicits fanning of the toes.

No longer seen by six months

Question 12

Stepping reflex

Answer 12

Walking motion made with legs and feet when held upright and feet touching the ground.

Appears in the first 3 to 4 months, then disappears at 12 to 24 months

Question 13

Rooting reflex

Answer 13

Turning up head and sucking one cheek is stroked.

No longer seen by 2-3 months

Question 14

2 month milestones

Answer 14

From tummy, can lift self up on 2 arms Response 2 sound

smiles when smiled 2

Question 15

4 month milestones

Answer 15

Reaches 4 a toy or other object.
Smiles 4 fun (spontaneously no trigger needed)
Rolls from tummy to back

Question 16

Six month milestones

Answer 16

Looks like a number six when SITTING UP unassisted.

Rolls from back to tummy and back.

Question 17

6 to 8 months milestone

Answer 17

Once able to sit up, able to pass object from one hand to the other. Brain is mature enough to recognize body as one.

Babbles, & ah/oh sounds

Question 18

12 months milestones or 1 year

Answer 18

Stands tall like a number one and walks on two legs

Question 19

18 month milestones

Answer 19

Can name single word objects.
Says “no” a lot also like an 18-year-old.
Acts like an 18-year-old by copying work that adults do.

Question 20

Two or 24 months milestones

Answer 20

Speaks in 2 word sentences.
Follows 2-step commands.
Can walk up to the 2nd floor with help.
Builds a 2 block tower with ease

Question 21

Three year milestones

Answer 21

Can draw a circle.
Can ride a tricycle.
Build a three block tower with ease. Speaks in three word sentences.

Question 22

Four year milestones

Answer 22

Can speak in 4 word sentences.
Can build a 4 block tower with ease.
Can draw a cross

Question 23

Time out

Answer 23

Time out should be introduced at 18 months (learning concept). At 24 months came out is more effective. The child should remain in time out for 1 minute per year of age. Ex) 2 mins for a 2 year old

Question 24

Intellectual speech by which age

Answer 24

By 3 1/2 nearly 100% of speech should be easily understood to others other than parents

Question 25

Rule of sixes with teeth

Answer 25

The first tooth eruption should be the upper and lower central incisors around 6 to 10 months.

Permanent teeth begin to irrupt at 6 years. They are usually the molars first

6 months for baby teeth and 6 years for adult teeth

Question 26

Adjusted age of preterm babies should be used to assess developmental age until what age?

Answer 26

2 years

micropreemies will take full two years but most babies will grow out of status before two years.

Question 27

Non-communicating hydrocele

Answer 27

A painless, tense, nonreducible, relatively symmetric scrotal enlargement that brightly and evenly transilluminates. With the position change there is no change in scrotal size.

Very common in the first year of life, will self resolved.

Caused by the ceiling of the abdominal cavity during gestation with residual trapped peritoneal fluid in the scrotal sac

Question 28

Communicating hydrocele

Answer 28

Caused by incomplete ceiling of the peritoneal cavity at the inguinal area during gestation leaving a space between the abdominal cavity and the scrotum.

Only difference in presentation from non communicating hydrocele - Size of the scrotum sack but increase or decrease with position change.

Due to communication, and infant is more at risk for herniation of the abdominal contents. Refer to pediatric urologist.

Question 29

Pyloric stenosis

Answer 29

Caused by thickening of the pylorus muscle, preventing food from moving from the stomach into the small intestines.

Post fed projectile vomiting is present, with the baby eager to eat again immediately post emesis.

More common in males

Olive shaped right upper quadrant abdominal mass occasionally noted.

Most common time for symptoms of onset are approximately at 3weeks - 6weeks of age.

US for diagnosis
Sent to ER - surgery correction required & iv hydration

Question 30

Intussusception

Answer 30

Caused when a secretion of intestines invaginate into the adjoined intestinal lumen, causing bowel destruction.

More common in males

Sudden onset colicky severe and intermittent abdominal pain. Often with these drawn to chest during most intense discomfort. Accompanied by a sausage shaped of abdominal mass.

Usually occurs between ages 6 to 12 months

Us for diagnosis
Sent to ER - hydrostatic or pneumatic enemas or surgical correction

Question 31

Developmental red flags in young children

Answer 31

By 6 month: no big smile or other warm, joyful expressions

By 9 months: no back-and-forth sharing of sounds smiles or other facial expressions

By 12 months: lack of response to name, no babbling or baby talk, and or no back-and-forth gestures, such as pointing, showing, reaching or waving

By 16 months: no spoken words

By 24 months: no meaningful two word phrases that don’t involve imitating or repeating

Question 32

Infant weight change

Answer 32

Neonate lose up to 7% of body weight but should regain it by two weeks of age. They doubled her birthweight by six months and triple their birthweight in 12 months.

Question 33

Acute URI should be treated with antibiotics when

Answer 33

Persistent illness or daytime cough more than 10 days without improvement

Worsening course or new onset of nasal drainage, daytime cough, or fever after initial improvement

Severe onset/concurrent fever of greater than 102.2F and purulent nasal drainage more than three consecutive days

Question 34

ABRS abx treatment

Answer 34

Amoxicillin 80 to 90 mg per kilogram per day
Or HD Augmentin PO

Course of therapy 10-14 days (differed from 5-10 day therapy recommended for adults)