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Clinical Medicine > Peds COPY > Flashcards

Peds COPY Flashcards

1
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

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2
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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3
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

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4
Q

nupple issues with breastfeeding

A

nipple or breast infections

dermatitis or psoriasis

inverted nipples

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5
Q

four issues that would inactivate surfactant

A

pulmonary hemorrhage

pulmonary edema

alveolar capillary leak

meconium

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6
Q

what percent of high school students exercise for 60 minutes daily

A

35%

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7
Q

4-5 month milestone

A

gross: head steady in supported position
fine: hands together
social: shows displeasure through vocalization
language: looks for the source of sound

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8
Q

suckle reflex

A

new born sucks when something is placed in the mouth

14 weeks

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9
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

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10
Q

diagnosing ID in children under 3.5

over 3

A

developmental testing

developmental testing, standardized tests, psych eval, vision and hearing test

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11
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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12
Q

OCD defined

A

upsetting, recurrent thoughts leading to repetitive actions

feeling to urge to do repitive actions to soothe anxiety

difficulty stopping the reccurent thoughts until ritual is complete

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13
Q

T/F breast milk is lacking in vitamin D

A

true

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14
Q

signs that infants can hear

6-7 months

A

turning to listen to voices and conversation

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15
Q

issues with breast reduction that can decrease milk production

A

interruption of ducts

decreased blood flow

nerve damage that decreases reflex arc

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16
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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17
Q

what is the action of phototherapy for jaundice in neonates

A

to formation of lumirubin that will bind with water and does not need to conjugated to be excreted

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18
Q

mammogenesis

A

development of breasts to a functional state

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19
Q

T/F electroconvulsive therapy has been show to have no positive effect in treating pediatric depression

A

false

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20
Q

treatment for ID

A

speech therapy

OT/PT

special education

behavior therapy

counseling

medical therapy if needed

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21
Q

DDx for pediatric depression

A

adjustment disorder with depressed mood

bipolar

sadness

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22
Q

24 month milestones

A

gross: throws ball overhead, jumps
fine: turns door knobs, builds a 7 block tower
social: washes and ries hands, little spilling during feeding
language: two or three words combined, points to body parts

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23
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

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24
Q

risk factors for pediatric depression

A

FHx of depression

family dysfunction

exposure to early difficulty (neglect, abuse)

low birth weight

TBI

gender dysphoria

substance abuse

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25
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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26
Q

when should head lag 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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27
Q

what does a gestational age assessment look at

A

neuromuscular and physical maturity

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28
Q

how would a preterm baby present posturally

A

full extension and no flexion

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29
Q

treatment for a plugged duct related to breastfeeding

A

check latch

warm compress

expression

analgesics

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30
Q

signs that infants can hear

3-4 months

A

turning eyes and head to sound

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31
Q

arm recoil test

how will this differ pretime to term

A

pull the arms down and se if the naturally recoil

a full term baby will naturally bring their arms back to less than 90, a preterm wont

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32
Q

symptoms of ODD

A

frequent temper tantrums

excessive arguing with adults

active defiance of adults

deliberate attempts to annoy upset people

frequent anger and resentment

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33
Q

intrauterine growth retardation

A

a conditions where a baby does not grow to a normal size

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34
Q

comorbid conditions with ASD

A

ADHD

depression

anxiety

frequent diarrhea

colitis

asthma

eczema

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35
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

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36
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

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37
Q

acute or chronic hypoxia is indicative of what

A

meconium aspiration

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38
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

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39
Q

T/F gross motor development progresses from the bottom up

A

false, it progresses from the head down

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40
Q

rooting: defined

A

touch a neonates cheek, head turns towards stimulus with an open mouth

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41
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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42
Q

failure to thrive

A

weight curve fallen by two percentile channels from previously established rate

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43
Q

acrocyanosis

A

cyanosis of the hands and feet

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44
Q

risk factors for childhood obesity

A

genetics

behaviors

environment

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45
Q

5 A’s for smoking cessation

A

ask

advise

assess

assist

arrange

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46
Q

two contraindications for breastfeeding

A

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

mother who have HIV

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47
Q

possible explanations why suicide rates are increasing

A

increased drug and alcohol abuse

depression

family/social disorganization

access to firearms

social media

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48
Q

how will the ear look on a preterm baby

A

cartilage looks more firm on a term than a preterm baby

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49
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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50
Q

klumpke palsy

A

paralysis of the forearm muscles

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51
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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52
Q

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

A

false, there is still a change to get pregnant

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53
Q

T/F most infants with kernicterus has show some sign of acute bilirubin encephalopathyq

A

true, but there are some with few clinical signs as well

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54
Q

what is the role of amniotic fluid

A

fetal breathing of amniotic fluid stimulates lung growth

if there isn;t enough fluid the baby gets pulmonaryt hypoplasia

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55
Q

erbs palsy

A

brachial plexus injury of C5-6, makes a claw hand, related to birth trauma from shoulder dystocia

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56
Q

risk factors for ASD

A

down syndrome, fragile X, rett syndrome

older parents

having a sibling with ASD

low birth weight

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57
Q

clinically significant brain abnormalities associated with FAS

A

changes in the corpus callosum, cerebellum, basal ganglia

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58
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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59
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

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60
Q

mongolian spots

A

flat blue grey spots that can be confused for bruises

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61
Q

what is the most common psychiatric condition across developmental stages

A

anxiety

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62
Q

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

A

false, other way around

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63
Q

social development milestones

15-18 months

A

independent

copies parents (18months)

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64
Q

rooting: duration

A

32 wks (incomplete gestation) or 36 wks (complete)

to 4 monts

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65
Q

oppositional defiant disorder

A

ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that interfere with daily function

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66
Q

ADHD symptoms

A

inattention

hyperactivity

impulsivity

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67
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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68
Q

T/F the etiology is intellectual disability is usually known

A

false, it is only known in 1/3 of patients

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69
Q

short term maternal benefits of breastfeeding

A

less postpartum bleeding

easier postpartum weight loss

delays ovulation

allows for mother/infant bonding

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70
Q

15-17 month milestones

A

gross: stoops and recovers, walks well
fine: builds 2-3 cube tower
social: attempts to use sppon
language: waves bye, uses 4-5 words

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71
Q

DDx of ASD

A

childhood psychoses

fragile X

hearing loss

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72
Q

pharmacotherapy for suicide

A

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

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73
Q

12-14 month milestones

A

gross: stands alone for 2 seconds
fine: bangs object together, places pellet in bottle
social: hugs dolls, uses gestures to indicate needs
language: uses one or two words with meaning

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74
Q

etiology of ASD

A

unknown, possible genetic or enviromental factors

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75
Q

social development milestones

1

2

6 months

A

regards face

recognize parents

likes looking around

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76
Q

biological factors associated with ODD

A

parent with ADHD, ODD, CD

parent with depression or bipolar

parent substance abuse

chemical imbalance

exposure to toxins

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77
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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78
Q

signs of hunger to indicate breastfeeding should start

A

increased alertness

mouthing or rooting

bringing hands to mouth

crying is the last one

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79
Q

how to treat reynauds associated with breastfeeding

A

warm the whole body

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80
Q

what is the best way to maximize milk production

A

infant feeding or pumping (not as effective)

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81
Q

9-11 month milestones

A

gross stands while holding on

fine: passes object from hand to hand
social: feeds self, imitates waving
language: undestands no, says mama

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82
Q

when is it ok the start breastfeeding after general anesthesia

A

when the mother is alert

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83
Q

conditions associated with excessive bilirubin production in neonates

A

blood group incompatibility

spherocytosis

G6PD deficiency

sepsis

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84
Q

neonate PE eyes, nose, jaw

A

eyes should be 2-3cm apart

nose flattened bridge

pierre robin small jaw

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85
Q

etiology of OCD

A

precise cause is unknown

some genetic correlation

dysregulation of serotonin

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86
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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87
Q

signs of advanced phase acute bilirubin encephalopathy

A

pronouced retrocollis-opisthotonos

shrill cry

no feeding

apnea

fever

stupor into coma

sz

death

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88
Q

when should supplemental feeding be considered

A

dehydration

<3 stools/day

loss of 7% birth weight

limited maternal milk supply

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89
Q

preventable causes of intellectual disability

A

FAS

maternal drug use

maternal malnutrition

infection

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90
Q

decreased risk factors for RDS

A

chronic inttrauterine stress

maternal HTN

IUGR or SGA

corticosteroids

thyroid homone

tocolytic agents

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91
Q

when is the period of most rapid head growth

A

0-2 months

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92
Q

four reflexs to note on neonate PE

A

root

suck

moro

grasp

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93
Q

0-2 month milestones

gross

fine

social

language

A

gross: turns head to side

fine: clenched fist with eye contact

social: recognizes human face

language: vocalizes in play

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94
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

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95
Q

abnormalities of functional skills of the CNS related to FAS

A

decreased cognition

motor delays

ADHD

social skill issues

language problems

others

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96
Q

why is breastfeeding preventative for uterine bleeding postpartum

A

it causes smooth muscle contraction and involution of the uterus

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97
Q

two symtom categories for ADHD

A

inattention or hyperactivity/impulsiveness

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98
Q

function of prolactin in breastfeeding

oxytocin

A

increases milk production

stimulates let down from the breast

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99
Q

reccomendations to decrease SIDs risk

A

sleep on back

firm surface

no bedding or pillows

share room, not bed

don’t smoke

offer pacifier

avoid overwrapping, overheating, head coverings

encourage tummy time while awake

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100
Q

neonate PE spine and extremities

A

curvatures, dimpling, bulging, exposed spinal cord

symmetry in appearance in movement, ROM, positioning

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101
Q

typical breastfeeding schedule during the first week

A

wake every four hours to feed

follow urine and stool

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102
Q

strategies to avoid memory issues associated with FASD

A

provide direction one rule at time

review rules regularly

repetition

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103
Q

underlying causes of failure to thrive

A

inadequate nutrition

GI reflux

neglect

poverty

ignorance

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104
Q

contraindications of breastfeeding

A

infant with galactosemia

HIV+

human T cell lymphotrophic virus

active TB

cytotoxic chemo

illicit drugs/alcohol

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105
Q

treatment of nipple yeat infections

A

topical antifungal

combination of antifungal

gentian violet

maternal fluconazole

infant nystatin

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106
Q

at what stage of acute bilirubin encephalopathy is the damage likely reversible

A

the intermediate stage if there is a blood transfusion

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107
Q

inattention ADHD symptoms

A

often fails to give close attention to details

trouble holding attention on tasks

doesn’t listen when spoken to

doesn’t follow thoruh with instruction or fails to finish tasks

trouble organizing tasks

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108
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

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109
Q

what does the skin of an immatue baby look like

A

red, shiny, tacky

if 24028 weeks there will be venous patterns on the trunk, head, and neck

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110
Q

DDx for ID

A

ASD

developmental delay

FAS

communication disorders

spoken language disorders

hearing loss

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111
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

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112
Q

when is formula used

A

if breastfeeding isn’t possible or desired

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113
Q

physical factors that contribute to SIDS

A

brain abnormalities

low birth weight

respiratory infeciton

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114
Q

6-8 month milestones

A

gross: rolls over, sits foward on arms
fine: reaching and raking
personal: responsed to own name, holds bottle
language: imitates speech and voice

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115
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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116
Q

positive barlow manuver

A

hip dislocation brought on by adduction of a flexed hip while pushing down on the thigh

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117
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

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118
Q

risk factors for recurrence of pediatric depression

A

presence of residual Sx

enviromental stressors

limited social support

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119
Q

DSM diagnostic criteria for ASD

A

presistant social communication and social interaction deficits

restrictive, repetative behaviors behaviors

symptoms present in early development

symptoms cause clincally signifcant impairment to function

disturbances are not explained by an intellectual disability

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120
Q

treatment of non-severe, low risk MRSA mastitis

A

dicloxacillin

keflex

clindamycin

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121
Q

misc SIDS risk factors

sex

age

race

FHx

2nd hand smoke

gestational age

A

boys > girls

most vulerable during the 2nd and 3rd month

black, native american, eskimo increased risk

FHx increases risk

2nd hand smoke increases risk

preature babies have a higher risk

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122
Q

infant benefits of breast feeding

A

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

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123
Q

palmar grasp: duration

A

28 weeks gestation to 4 months

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124
Q

ways to decrease milk production

A

stress (inhibits milk let down)

smoking

supplementation with formula

engorgment

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125
Q

36 month milestones

A

gross: stands on one foot for 2 seconds
fine: copies circle
social: takes turns, toliet trained
language: uses pronouns, gives names

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126
Q

omphalocele

A

intestines and abdominal organs are formed out side the body

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127
Q

involution

A

regression and atrophy post lactation

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128
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

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129
Q

galactokinesis

galactopoiesis

A

ejection of milk

maintenance of lactation

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130
Q

diastasis recti

A

separation of the rectus

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131
Q

poplital angle

A

try to draw leg up to the ear, a preterm baby will allow more extension of the knee

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132
Q

memory issues with FASD

A

information recall (learning, test taking, directions)

putting things from memory in sequential order

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133
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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134
Q

positve barlow, ortolani, or hip click lasting more than one month should be referred

A

true

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135
Q

factors that indicate decreased risk for jaundice after discharge

A

TSB in the low risk zone

gestational age 41 weeks

exclusive bottle feeding

black

discharge after 72 hrs

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136
Q

treatment of severe mastitis

A

inpatient IV vancomycin

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137
Q

ortolani manuver

A

PE of a new born that checks for hips dysplasia

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138
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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139
Q

what are the two main periods of increasing length

A

infant and adolescence

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140
Q

kerion

A

abscess from a fungal infection

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141
Q

how much weight should a baby gain

A

15-30 (.5-1 oz) everyday

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142
Q

social development milestones

6

8

12 months

A

strangers

expoloring+pat a cake

imitation, comes when called

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143
Q

hyperoxia challenge test

A

giving a neonate with RDS supplmental oxygen resolves cyanosis, indicative of pulmonary or noncardiovascular origin

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144
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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145
Q

presentation vs diagnosis of symptoms in ASD

A

symptoms usually present in the first 2 years but no diagnosed until age 4

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146
Q

differentiate length vs height

A

length is laying down

height it standing

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147
Q

gastroschisis

A

baby’s intestines are out side of the abdominal cavity

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148
Q

root reflex

A

stroking the cheek will cause the baby to turn their head to ward the stimulus

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149
Q

scarf sign

A

when the preterm babies arm is pulled across their neck they wont fight

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150
Q

what is the probability that pediatric obestity will progress into adulthood

A

20% at 4 years

80% at adolescence

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151
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)

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152
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

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153
Q

moro (startle) reflex: duration

A

28wks to 3 onths

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154
Q

gross motor development milestones

rolling

sitting

crawling

A

4 months

6 months

9 months

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155
Q

capur succeduaneum

A

swelling of the scap of a neonate brought on by pressure of the being forced out of the vagina

crosses midline

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156
Q

pierre robin

issues with transport and intubation

A

babies with no lower jaw or very small one, commonly have stridor and tongue obstruction

easiest to transport prone and hard to intubate

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157
Q

comorbid conditions for ODD

A

ADHD

learning disabilities

mood disorders (depression, bipolar)

anxiety

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158
Q

meconium

A

the first newborn stool made of epithelium, hair, mucus, bile

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159
Q

what should cause an increased (bad) score on scarf test

A

obesity, chest wall edema, short humerus, shoulder girdle hypertonicity

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160
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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161
Q

moro (startle) reflex: defined

A

hold the baby supine, allow a head dropof 1-2 cm. arms will abduct and elbows flex with fingers spread

follwed by adduction with flexion

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162
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

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163
Q

guidelines for phototherapy in neonatal jaundice

500-1000g

1000-1500g

1500-2500g

>2500g

A

bilirubin 12-15 mg/dL

15-18

18-20

>20

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164
Q

hyperactive ADHD symptoms

A

fidgets a lot

leaves seat often

unable to play quietly

talks alot

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165
Q

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

A

5lbs

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166
Q

PE findings that indicate RDS

A

cyanosis on room air

RR +60

grunting

sternal and intercostal retractions

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167
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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168
Q

fine motor milestones

15-18 months

A

use a spoon and cup

2 block tower

scribbles

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169
Q

what is the most common chronic disease of childhood

A

dental caries

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170
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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171
Q

sideffects of SSRI (pediatric depression)

A

abdominal pain

diarrhea

nausea

headache

sleep changes

cardiac events

suicidal thoughts

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172
Q

fine motor development milestones

6 months

9 months

12 months

A

transfer object and raking

immature pincher

matuer pincer

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173
Q

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

A

lose 1 lb per month

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174
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

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175
Q

galactogogues

two types

A

medications that can increase milk supply

reglan, fenugreek

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176
Q

treatment for failure to thrive

A

correct underlying cause (usualyl inadequate intake)

look at social environment for poor eating or learned behavior

177
Q

how should the ears line up in relation to the eyes

A

the eye and the ear should be on a horizontal line, if the ear is low set it can be indicative of a chromosomal problem

178
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

179
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

180
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

181
Q

three reasons why newborns are predisposed to jaundice

A

increased bilirubin load

increase entreoheaptic recirculation

immature hepatic metabolism

182
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

183
Q

eye fusing

A

eyes fused suggested a gestational of 26 weeks

184
Q

hypospadias

A

opening of the urethra on the dorsal surface of the glans

185
Q

categorize these from top to bottom

A

1 month no head up

2 months about 45 deg

4 months head up and rolling

186
Q

RDS chest xray

A

ground glass appearance, hazy, air bronchograms

187
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

188
Q

why is fiber very important for toddler nutrition

A

prevention of constipation

189
Q

comorbid condition associated with OCD

A

other anxiety disorders

tic disorders

depression

ADHD

oppositional defiant disorder

190
Q

IURG (intrauterine growth restricted)

two types

what does this put them at risk for

A

assymterical: head too big for their body

191
Q

what is the most important indicator of gestational age

how accurate is it

A

posture

accurate with in one week

192
Q

how will DTRs in an infant appear

A

brisk, possibly with clonus

193
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

194
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

195
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

196
Q

language development milestones

18 months

2 years

A

know 5 body parts

2 word sentances, “what”, 50 word vocab

197
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

198
Q

BMI in pediatrics is based on the number or their percentile

A

percentile

199
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

200
Q

what is preferred method of infant nutrition

A

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

201
Q

ADHD treatment (school aged)

types of medication

A

start with medication plus behavior therapy

methylphenidate

amphetamine

dextroamphetamine

202
Q

causes of nipple and breast pain

A

breast pump use

nipple vasoconstriction from reynauds

engorgment

plugged duct

nipple issues

203
Q

what causes breast milk jaundice in health infants

what is the treatment

A

familial tendency

active reabsorption of bilirubin

withhold breast feeding for 24 hours then resume

204
Q

management of RDS

A

antenatal steroids

surfactant replacement

CPAP

mechanical ventiliation

ABx

sedation

205
Q

Dx of OCD

A

SCARED screen

childrens yale-brown obsessive compulsive scale

206
Q

infant

A

birth to one year

207
Q

AAP reccomendation for TV

A

no tv before 2, max 2 hrs after 2

208
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

209
Q

neonate PE thorax

A

symettry, retractions, precordial activity

contour of the abdomen and number of vessels in the cord

210
Q

intellectual disability involved impairment in what two areas

A

intellectual ability (IQ <75)

lack of adaptive behaviors (hard time learning but can communicate)

211
Q

what is the leading cause of morbidity/mortality in adolescents

A

MVA, frequently involving alcohol or texting

212
Q

behavior therapy for teachers and parents to implement with ADHD kids

A

keeping a schedule

keeping distractions to a minimum

having a place for all their things (toys, books, etc)

setting small, reachable goals

rewarding positive behavior)

213
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

214
Q

typical onset of OCD

A

10, but can start as early as 6

215
Q

acrocynanosis

A

constriction of small arterioles that leads to cyanosis in the hands

216
Q

mongolian spots

why is it important to document

A

skin discoloation

can be mistaken for a bruise and lead someone to think there is abuse

217
Q

ADHD treatment (pre school)

A

start with behavior therapy with positive reinforcement

add stimulants if therapy is ineffective

218
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

219
Q

neurochemical etiology of ADHD

A

deficiency of dopamine and norepinephrine

220
Q

signs of kernicterus

A

cerebral palsy

auditory dysfunction

dental enamel dysplasia

paralysis of upward gaze

intellectual handicaps

221
Q

lanugo

what does it mean in term of prognosis

A

fine hair on the baby

more lanugo means the baby is more viable

222
Q

why are newborns predisposed to jaundice due to increased bilirubin load

A

decreased life span of RBCs

increased RBC volume

small amount of internal bleeding

223
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

224
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

225
Q

pharmacotherapy treatment for obese children

A

orlistat (lipase inhibitor) approved for >12 yrs old

226
Q

neonate PE color

A

cyanosis of hands an feet is normal, jaundice is abnormal

227
Q

potential complications of childhood obesity

A

HTN

dyslipidemia

DMII

sleep apnea

mental health problems

orthro issue

228
Q

nenonate

A

less than 4 weeks old

229
Q

48 month milestones

A

gross: hops on one foot
fine: wiggles thumb, copies cross
social: dresses self
lanuage: knows colors, asks questions

230
Q

typical pattern for failure to thrive

A

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

231
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

232
Q

why is sharing difficult to learn at age 3

A

because children lack empathy to understand that not everything is theirs

233
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

234
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

235
Q

polydactyly

A

multiple fingers and toes

236
Q

failure to thrive

A

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

237
Q

TORCH infections

A

Toxoplasmosis

Other (syphylis, chicken pox, parovirus)

Rubella

Cytomegalovirus

Herpes

238
Q

comorbid conditions associated with ADHD

A

any mental, emotional, behavior disorders

behavior issues

anxiety

depression

autism spectrum

tourettes

239
Q

treatment for engorgement related to breast feeding

A

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

240
Q

kernicterus

at what level of hyperbilirubinemia will this occur

what will it cause

A

a conditon where bilirubin passes the blood brain barrier

20-25 mg/dL

encephalopathy

241
Q

facial dysmorphia related to FAS

A

smooth philitrum

thin vermilion border

small palpebral fissures

micrognathia

epicanthal folds

minor ear abnormalities

242
Q

treatment for OCD

A

cognitive behavior therapy

medications (SSRIs, tricyclics)

243
Q

suck reflex

issues with develipment

A

when the roof of the babies mouth is touched they wil begin to suck

usually doens;t present until 32 weeks and not fully developed until 36 weeks

244
Q

lanugo

A

thin soft hair found on newborns

245
Q

palmar grasp: defined

A

newborn closes fingers around object placed in hand

246
Q

what is acnthosis nigricans indicative of

A

high levels of insulin

247
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

248
Q

how long after drinking should breastfeeding be allowed

A

2 hours after a single drink

249
Q

what is the economic benefit of breast feeding

A

saves $1200/yr on formula

lower healthcare issues due to fewer illnesses

250
Q

fine motor milestones

2 years

3

4

A

6 block tower

draw circle, clothes off

draw a cross

251
Q

post mortem finding most consistent with SIDs

A

intraothoracic petiechiae with mild inflammation and congestion of the respiratory tract

252
Q

language development milestones

2 months

4 months

6 months

A

smile

laugh

babble

253
Q

heel to ear

A

take both letgs to the ears without lifting the hips off the table, preterm will allow rhis

254
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

255
Q

what is the issue with fenugreek supplmentation for breast feeding

A

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

256
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

257
Q

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

A

2

258
Q

causes of pediatric malnutrition

A

inadequate intake from eating disorders or limited access

celiac disease

crohns

chonic liver disease

259
Q

galactosemia

symptoms

A

inborn error of metablism that leads to accumulation of galactose

failure to thrive, liver dysfunction, mental retardation

260
Q

treatment for pediatric depression

A

SSRI/SNRI (fluoxetine)

261
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

262
Q

comorbid conditions associated with intellectual disability

A

CP

epilepsy

ADHD

ASD

depression

263
Q

specific symptoms of ASD

A

little to no eye contact

abnormal response when someone tries to get their attention

unusual tone of voice

flat affect

echolalia

extreme focus

hyper/hyposensitive to sensory input

264
Q

what constitutes a pre term baby

three conditions to be manage

A

<37 weeks

sepsis, thermoregulation, RDS

265
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

266
Q

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

A

false, there is some evidence for school based support

267
Q

what is the best way to support breastfeeding after birth

A

skin to skin contact increases breastfeeding by 42.6 days

268
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

269
Q

around when will children begin to show imagination

A

3-5 years

270
Q

ear tags/ear pits are possibly indicative of what

A

kidney malformation because they are formed at the same time

271
Q

what demographics have increased risk of depression

A

teenage girls and minorities

272
Q

maternal risk factors for SIDS

A

younger than 20

smokes

drugs or alcohol

inadequate prenatal care

273
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

274
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

275
Q

general screening questions for suicide

A

depression

substance abuse

hx of violence, victimization, or witnessing violence

276
Q

blood gas workup for RDS

A

high CO2, low O2

277
Q

common features of fetal alcohol syndrome

A

craniofacial dysmortpholgy

growth deficits

neurological abnormalities or deficits

278
Q

what is the most important part of a apgar score

A

the progression or lack thereof (apgar 4 to 9 is ok, 4 to 4 is worrisome)

279
Q

four growth parameters to measure

A

head circumference

length

weight

BMI

280
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

281
Q

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

A

postpartum depression

282
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

283
Q

etiology of intellectual disability

A

problems during pregnancy or child birth

genetic conditions

illnesses

injuries

284
Q

staged approach to treating obesity

A

prevention plus

structured weight management

comprehensive multidisciplinary

tertiary care intervention

285
Q

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

A

true

286
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

287
Q

what is the lag time in SSRI treatment

A

4-6 weeks before there is an appreciable effect

288
Q

clinical course for depression in children

adolescents

A

most end in 8-13 months with a 30-70% relapse

most end in 4-9 months, 90% within 2 years, 20-70% relapse

289
Q

treatment for childhood obesity

A

eat less do more

290
Q

clincal diagnosis of pediatric anxiety

A

HP

anxiety screen (screen for anxiety related emotional disorders)

labs

291
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

292
Q

social development milestones

2

3

4 years

A

parallel play

group play, sharing, taking turns

associate gender specific categories, competition

293
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

294
Q

depression standardized tools for pediatrics

A

mood and feelings questionaire

beck depression inventory

child depression inventory (7-17)

reynolds adolescent depression (grades 7-12)

295
Q

maturity of male genitalia

female

A

presence of testis, degree of descent, developemtn of rugea on the scrotum

prominence of the clitoris, develpment of labia minora/majora

296
Q

signs of early phase acute bilirubin encephalopathy

A

severe jaundice

lethargy

hypotonic

poor nursing

297
Q

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

A

false

298
Q

pellegra

risk factor

solution

A

a niacin deficiency

maize based diet

foods rich in protein and whole grains

299
Q

2-3 month milestones

gross

fine

social

language

A

gross: lifts head
fine: tracks objects past midline, opens hands
social: smiles responsively
language: vocalizes in play

300
Q

sheehands syndrome

A

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

301
Q

citalopram is associated with what risk for what (used to treat depression)

A

long QT syndrome and sudden cardiac death

302
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

303
Q

18-21 month milestones

A

gross: runs well, kicks ball, walks backwards
fine: scribbles, turns book pages
social: drinks from cup, uses spoon, feeds self
language: follows simple commands, has 20-50 words

304
Q

why are most others induced at 41-42 weeks

A

because the placent doesn’t function as well at this point and can injure the baby

305
Q

environmental contributors to SIDS

A

side or stomach sleeping

sleeping on a soft surface

cosleeping

306
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

307
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

308
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

309
Q

psychological etiology of ODD

A

poor relationship with parents

neglectful or absent parents

difficultly forming social relationships

310
Q

three phases of acute bilirubin encephalopathy

A

early, intermediate, advanced

311
Q

four centers in the brain associated with ADHD

A

frontal cortex (attention, organization, executive function)

limbic system (emotions)

basal ganglia (inattention, impulsivity)

reticular activating system (inattention, impulsiviity, hyperactivity)

312
Q

five types of anxiety disorders

A

generalized anxiety

social anxiety

separation anxiety

OCD

phobias

313
Q

treatment for parents and care givers

A

positve reinforcement

be a good role model

pick your battles

set up age appropriate limits with consequences

maintain a life away from your kid

314
Q

cephalohemotoma

A

traumatic subperiosteal hemotoma that occurs under the skin

315
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

316
Q

BMI standard for peds

A

underweight <5%

healthy 5-84%

overweight 85-94%

obese >95%

317
Q

what is the most common reason why a baby is born prematurely

signs of this

A

sepsis from infection

cloudy or smelly amniotic fluid

318
Q

syndactyl

A

fingers or toes that are attached to each other

319
Q

what typically causes jaundice ina neonate

A

infection or hemolytic process

320
Q

symptoms of ID

A

deficieits in intellectual functions (language development, reasoning, problem solving, planning, judgement)

deficits in adaptive learning (fails to become independent, limited functioning in daily activities)

321
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

322
Q

what is considered small for gestational age

large

A

10th percentile or less

90th perctile or more

323
Q

when do infants develop full color vision

A

7 months

324
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

325
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

326
Q

ankyloglossia

A

baby born with a short frenulum that limits tongue extension

327
Q

when will primary teeth erupt

what factors can change this by one month

A

7 months

gestational age <37 weeks or birthweight <2500g increases that by one month

328
Q

genetic correlation of ADHD

prevalence

A

70-80% genetic

5 %

329
Q

intellectual disability prevalence and gendrer bias

A

1% have it, 85% of those are mild

males affected more than females

330
Q

who diagnoses ASD

A

general practitioner makes initial screen

specialized evaluation by psych, speech pathology, pediatricians

hearing screens or lab tests to rule out other causes

331
Q

neotnate PE vital signs

A

HR 120-140 preterm 140-160

heart sounds split s2 normal with no murmurs

RR 40-60

332
Q

SIDs demographic bias and risk factors

A

more likley among minorities and low SES

RFs: low birth weight, teen mothers, drug addiction, multiparity, FHx

333
Q

nonstimulant treatment for ADHD in school aged children

A

atomexetine (strattera)

buproprion (wellbutrin)

guanfacine

334
Q

moro reflex

how long is it present

A

a loud sound will cause the baby to throw back their head, extend their arms, cry, then pull the limbs back in

lasts about 5-6 months

335
Q

why are newborns predisposed to jaundice due to immature hepatic circulation

A

decreased bilirubin uptake

decreased conjugation

336
Q

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

A

dietary history

activity log

337
Q

what is the square window

how sshould this change as the baby gets older

A

the angle between the palm and the flexor surface of the arm when the hand is flexed

the angle should decreased as gestational age increases

338
Q

pulmonary air leaks found with meconium aspiration

A

pneumothorax

pneumomediastinum

pneumopericardium

pulmonary interstitial emphysema

339
Q

reasons parents should avoid juice

A

cavities

malnutrition

short stature

perioral rash

diarrhea

GI symptoms

340
Q

signs of intermediate phase acute bilirubin encephalopathy

A

stupor

irritability

hypertonia of the neck and back

fever with high pitched cry

341
Q

treatment of ASD

A

early treatment is important

involves therapy and medication

social service programs

life style modification

342
Q

combined presentation of ADHD vs predominantly inattentive or hyperactive

A

allows for inattentive and impulsive criteria if there are enough present for six months

343
Q

symptoms of pediatric anxiety

A

overly tense and uptight

constant fears of safety

refusal to goto school

extreme worries about sleeping away from home

clingy

difficulty sleeping

344
Q

what would cause a spuriously low (good) score on scarf sign

A

brachial plexus injury or general hypertonicity

345
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

346
Q

DDX for ADHD

A

age approproate activity

mood disorders

anxiety disorders

ASD

substance abuse

347
Q

primary disabilities related to FASD

A

lower IQ

impaired abilites in reading or math

lower level of adaptive functioning

commonly diagnosed with ADHD

348
Q

T/F phototherapy bleaches the skin and makes jaundice more prominent

A

false, it makes it harder to see and makes visual assessment of jaundice unreliable

349
Q

fetal erythroblastosis

A

hemolytic anemia in the fetus caused by antibody incompatibility between the mother and fetus

350
Q

reccomendations for HIV breastfeeding

A

formula in developed countries

breastfeeding in poor countries

351
Q

what is the function of surfactant

A

decreases surface tension

maintains functions residual capacty

352
Q

gross motor development milestones

hops on 1 foot, go down stairs alternating feet

jumps over things

A

4 years

5 years

353
Q

when should the transition to cup and utensil feeding happen

A

as soon as possible

354
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

355
Q

how will the plantar surface of a preterm bbaby look like

A

preterm will have a more smooth foot

356
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

357
Q

fetal alcohol syndrome

A

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

358
Q

Dx of pediatric depression

A

HP

PE

mental status exam

labs (CBC, CMP, TSH, Urine)

359
Q

components of neuromuscular maturity

A

posture

square window

arm recoil

popliteal angle

scarf sign

heel to ear

360
Q

treatment for ODD

A

therapy

medication at trating some of the more severe symptoms

treatment of comorbid conditions

361
Q

Risks of insufficent feeding

A

dehydration

elevated bilirubin

re-hospitalizxation

acute renal failure -> shock, sz

362
Q

social etiology of ODD

A

poverty

chaotic environment

abuse

neglect

lack of supervision

363
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

364
Q

how many vessesls hould be in the umbilical cord

A

two veins and one artery

365
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

366
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

367
Q

OCD cycle

A

obesseion, anxiety, compulsions, relief

368
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

369
Q

what demographics are most likely to be obese

A

hispanic boys and black females

370
Q

fine motor milestones

4.5

5

A

draw square, clothes on, buttons, catch ball

tie shoes

371
Q

do exercise or contraception have an effect on lactation

A

little if any

372
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

373
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)

374
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

375
Q

5 yr milestones

A

skips using alternating feet

fine: holds a pencil correctly
social: brushes teeth without help
language: easily carries convestaion, counts, does ABCs

376
Q

treatment for breast feeding jaundice

A

nursing as soon as possible after delivery

frequent nursing for the first few days

do no limit nursing time

377
Q

problems that can least to milk extraction issues

A

insufficient nursing and poor feeding schedule

problems with latch

ankyloglossia

378
Q

treatment for anxiety

A

therapy (cognitive behavioral therapy)

medications (SSRI)

379
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

380
Q

how do you know if a baby is breastfeeding well

A

are they gaining weight

content/active/alert

wet or dirty diapers regularly

381
Q

specialized tests for diagnosing intellectual disability

A

genetic testing

brain imaging (micro/macrocephaly)

metabolic screen

382
Q

gross motor development milestones

cruising

walking

walking backward

running

A

10-11 months

12 months

15 months

18 months

383
Q

questions to ask if you think there is a suicide risk

A

content, nature, chronicity of thoughts

planning

details of the plan

384
Q

hallmark features of ASD

A

altered communiations/interactions with others

repetitive movements

restricted interests

all these symptoms interfere with functioning at home/school/etc

385
Q

scurvy

risks

solution

A

vitamin C defiency

diet without fresh fruit and a low fat intake

more fruit, veggies, liver, animal milk

386
Q

positive ortolani

A

dislocation of the hip by abducting the thigh that will elict a clunk or a spasm

387
Q

treatment of mastitis

A

nsaids, cold compressess

continue breast feeding

ABx

388
Q

conditions sequelae to pediatric malnutrition

A

illness

stunted growth

hyperactivity

aggression

anxiety

mental disabilities

389
Q

how to estimate adult heigh based on height at age 2

A

take the height and double it

390
Q

three most common causes of hyperbilirubinemia in infants

A

physiologic jaundice, prematurity, breastfeeding jaundice

391
Q

how many women start breast feeding

how many continue breast feeding until 6 months

A

81%

50%

392
Q

risk factors for OCD

A

family Hx

stress

393
Q

prevalence of ODD

gender, age, SE bias

A

up to 16%

no gender or SE bias

394
Q

cognitive difficulties for a person with FASD

A

taking and retaining infrmation (sensory integration)

recollection

using informaiton in a specific situation

395
Q

what would abnormal red reflex indicate

A

glaucoma or cataracts

396
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

397
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?
398
Q

what is the calorie need of toddlers

how much of that is fat

A

1000, half from fat

399
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)

400
Q

measurements and observations to help dectect pediatric obesity

A

plot trend on ht, wt, bmi

blood pressure

note on adiposity

labs

401
Q

signs of satiety after breast feeding

A

relaxation of arms and elgs

eyes close

falling asleep

402
Q

specific causes that lead to failure to thrive

A

lack of appetite (anemia, CNS issues)

difficulty swallowing

unable to get food

vomitting

malabsorption

diarrhea

inadequate absorption of calories

increased metabolism

403
Q

grasp reflex

how long is this present

A

stroking the palm causes the babies hand to close

5-6 months

404
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

405
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

406
Q

PANDAs related to strep

A

some patients don’t show signs of OCD until they have a strep infection

407
Q

decreased conjugation of bilirubin in neonates is related to wha conditions

A

physiologic jaundice

gilbery syndrome

crigler-najar syndrome

408
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

409
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

410
Q

what constitutes a term baby

four conditions to manage

A

37-42 weeks

sepsis, pneumonia, birth asphyxia, meconium aspiration

411
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

412
Q

post term baby

two conditions to manage

A

>42 weeks

asphyxia related complications and sepsis

413
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

414
Q

risk factors for development of hyperbilirubinemia in infants older than 35 weeks gestation

A

predischarge TSB in the high risk zone

jaundice in the first 24 hours

blood group incompatibility

known hemolytic disease

gestational age 35-36 weeks

415
Q

treatment of non-severe, moderate MRSA mastitis

A

trimetoprim-sulfamethoxazole

clindamycin

416
Q

increased risk factors for RDS

A

prematurity

male

familial dispositon

c section

chorioamnionitis

hydrops

maternal diabetes

417
Q

two causes of neonatal jaundice

A

excess production of bilirubin

decreased rate of conjugation

418
Q

what is the gender bias in ADHD

how do they present differently

A

males more than females

men more hyperactive

women more inattentive

419
Q

T/F the use of homephototherapy or sunlight exposure in the treatment of jaundice in neonates is effective

A

false, it is reserved for those with optional phototherapy needs or excluded all together as a theraputic tool (sunlight)

420
Q

what are the gender or racial bias of pediatric OCD

A

none in either category

421
Q

the five steps of lactation physiology

A

mammaogenesis

lactogenesis

galactokinesis

galactopoiesis

involution

422
Q

secondary disabilities associated with FAS/FASD

A

mental health issues

school issues

trouble with the law

inappropriate sexual behavior

substance abuse

423
Q

what is the peak time for SIDs

A

2-4 months in age, between 12am and 8 am

424
Q

diagnostic conditions for ADHD

A

6+ symptoms under 16, 5+ symptoms over 17

present for at least 6 months

symptoms inappropriate or disruptive

symptoms are present in two or more settings

clear evidence that the symptoms interfere with social functioning

symptoms are not better explained by another condition (anxiety, dissociative disorder, schizophrenia)

425
Q

stragegies to deal with executive functioning in FASD

A

use short term consequences

establish achievable goals

provide skill training that uses role play

426
Q

how many/how long symptoms need to be present to diagnose ODD

A

>4 symptoms for >6months

427
Q

DDx for OCD

A

depression

bipolar

eating disorders

body dysmorphic disorder

hoarding disorder

428
Q

symptoms of pediatric depression

A

depressed

decreased interest

change in appetite weight

sleep issues

psychomotor agitiation or retardation

fatigue

429
Q

risks of meconium aspiration

A

air leak of ball valving (atelectasis, pneumothorax)

chemical pneumonitis

pulmonary HTN

430
Q

T/F abnormal flucuations in appetite are abnormal

A

false, they are normal and should be expected

431
Q

comorbid consitions for depression related to CV issues

A

diabetes

obesity

sedentary lifestyle

smoking

432
Q

management of meconium aspiration

A

pulmonary toliet

umbilical lines

oxygen monitoring with mechanical ventilation

chest xray to rule out air leaks

ABx

surfactant

ECMO

433
Q

forms for ADHD

A

vanderbitl form

conners scale

434
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

435
Q

drugs that can decrease milk production

A

decongestants, antihistamines

436
Q

pulmonary causes of respiratory distress

A

choanal atresia

transient tachypnea ofthe newborn

fluid aspiration (blood or meconium)

hyaline membrane disease

congenital pnemonia from rectal flora

437
Q

two conditions that might cause surfactant deficiency

A

prematurity

infant of a diabetic mother

438
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

Clinical Medicine (11 decks)

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