Peds Final Flashcards
1
Q
what is the definition of delayed puberty in females?
A
no thelarche by age 13
2
Q
what is considered precocious puberty in girls?
A
SMR 2 < 8 y/o
3
Q
what is an abnormally long period of time between thelarche and menarche?
A
> 3-5 years
4
Q
what is considered precocious puberty in boys?
A
SMR 2 < 9 y/o
5
Q
what age is considered delayed puberty in males?
A
no testicular growth by age 14
6
Q
at what age do providers usually start talking to kids alone?
A
11-12
7
Q
when should the sex talk happen?
A
5th or 6th grade to delay coitarche
8
Q
how many adolescents report using alcohol by the 10th grade?
A
50%
9
Q
how many adolescents report being drunk at least once in high school?
A
50%
10
Q
how many adolescents have tried marijuana in high school?
A
44%
11
Q
when is growth hormone irrelevant?
A
1st year of life
12
Q
when should insulin be started in a child presenting with DMII?
A
ketones and glucose > 300mg/dL
13
Q
what is considered overweight in children?
A
> 85%-95%
14
Q
what is considered obese in children?
A
> 95%
15
Q
what is the 5-2-1-0 rule for obesity in kids?
A
5 servings fruits/veggies
2 hrs screen time
1 hour physical activity
0 sweetened beverages
16
Q
when is strabismus normal?
A
< 4months (esodeviations)
17
Q
when can you just observe AOM?
A
1) unilateral AOM w/o otorrhea 6-2 y/o
2) unilateral or bilateral AOM w/o otorrhea >2yrs
18
Q
when is follow-up required for AOM? and when?
A
when doing observation (48-72 hrs)
19
Q
when is fever typically high with infection and is not too concerning?
A
first 6 yrs of life
20
Q
what is the most common cause of URI?
A
rhinovirus
21
Q
what age range is it recommended that cough medication be avoided?
A
<6
22
Q
what has shown affect over placebo for cough?
A
honey (>1 y/o)
23
Q
how long is the typical URI?
A
7-9 days
24
Q
dx criteria for acute bacterial sinusitis (need 1)
A
1) sx present for >10 days
2) sx worsen w/new onset of fever or cough
3) associated w/temps >39C > 3 days
25
when is the earliest allergic rhinitis tends to appear?
10-12 months
26
when do seasonal allergies typically appear?
3-4 y/o
27
what are antihistamines not really effective for?
congestion and postnasal drip
28
where does most epistaxis originate from?
Kiesselbach area
29
4 keys mono sx
1) tonsillar exudates
2) cervical LAD (more often posterior)
3) fever
4) +/- spleen enlarged
30
hand, foot, mouth sx
1) posterior pharynx ulcerations
| 2) maculopapular or vesicular rash on hands and feet
31
what is the Centor 4 point scale used for?
strep
| the more points, the more likely it is strep
32
what is included in the Centor 4 point scale
1) fever
2) absence of cough
3) anterior cervical adenopathy
4) tonsillar exudates
33
how many criteria of the Centor 4 point scale should a patient meet in order to be strep tested?
3
34
what is scarlet fever?
strep with a rash (may have strawberry tongue)
35
PANDAS
subset of kids that get OCD or ticks after having strep
36
what is the Brodsky scale?
measure how much of oropharynx is taken up by the tonsils
37
what are the sx of acute rheumatic fever?
1) arthritis
2) carditis and valvulitis
3) CNS involvement
4) erythema marginatum
5) subcutaneous nodules
38
when is croup most common?
6-36 months
39
how is croup spread?
direct contact, droplets, fomites
40
what are the primary causes of croup?
parainfluenza type 1 & 2
41
what is the barking cough associated with?
croup
42
what distinguishes croup from epiglottitis?
presence of cough & absence of drooling
43
when is epiglottitis most common?
2-6 y/o
44
in what condition does the thumbprint sign appear on neck XR?
epiglottitis
45
when are the peaks for JIA?
1-3
| 8-12
46
what is the timeframe necessary to dx JIA?
> 6 weeks
47
what is Still's disease?
systemic JIA (inflammation preceding onset of arthritis
48
rheumatoid factor in JIA
negative
49
what screening is required in all patient with JIA? why?
uveitis because it is a common complication and can be asx but lead to blindness
50
what is the remission rate of JIA proportional to?
the # of joints involved
51
what are the skin manifestations of JDM?
1) heliotrope rash
2) Gottron's papules
3) periungual erythema
52
what is Gower's sign? which disease is it seen in?
when prone, get into downward dog and walk body up due to muscle weakness
JDM
53
which MSK dz causes large LE joints?
HSP
54
what is the characteristic lab finding in HSP?
leukocytoclastic vasculitis with IgA deposition
55
what must patients not have in HSP?
thrombocytopenia
56
what ages can use the pavlik harness for DDH?
0-6 mon
57
what are the 2 signs of DDH?
1) asymmetrical creases
| 2) Galeazzi sign
58
is DDH more often unilateral or bilateral?
unilateral (L>R)
59
what are the PE tests involved in DDH?
Barlow (dislocation) and Ortolani (reduction)
60
what movement is decreased in avascular necrosis of the femoral head?
internal rotation and abduction
61
what can be seen on film in late avascular necrosis?
flattening of femoral head
62
internal femoral torsion is more common in which age group?
> 2y/o
63
internal tibial torsion is more common in which age group?
<2 y/o
64
when do genu varum and genu valgum usually resolve by?
5-8 y/o
65
what is the most common polydactyly?
fusion
66
what is a mild scoliosis curve?
10-30 degrees
67
what age group is susceptible to nursemaid's elbow?
<5 y/o
68
when is a nursemaid's elbow painful?
with activity
69
how does child hold arm with nursemaid's elbow?
pronated and held close to body with elbow extended or slightly flexed
70
how is bronchiolitis dx?
clinically
71
what is the MC cause of bronchiolitis?
RSV
72
what should infants receive if they are at increased risk airway obstruction w/bronchiolitis?
Synagis (palivizumab) monthly
73
which infants specifically should receive pavilizumab as ppx?
1) infants born premature
2) <12 mon at onset of RSV season
3) chronic lung disease of prematurity
74
what are the 3 stages of pertussis?
1) catarrhal - cough + rhinorrhea (1-2wks)
2) paroxysmal - whooping cough and emesis (2-8wks)
3) convalescent - gradual waning of sx (wks-mons)
75
what tests are used for pertussis dx?
PCR and culture
76
what is the real point of treating pertussis?
limiting spread
77
what is the difference between the clinical presentations of viral and bacterial PNA?
viral - cough, wheezing, URI sx
| bacterial - high fever, chills, cough, dyspnea, focal lung findings
78
how old is old enough to dx asthma?
long enough to have had at least 4 recurrent episodes
79
how is asthma dx?
spirometry - incr FEV1 of >200mL and 12% from baseline after take SABA
80
at what age is spirometry reliable?
5 y/o
81
what is the tx for exercise induced asthma?
pre-tx w/albuterol 2 puffs at least 15min prior to exercise
82
which classifications of asthma should be treated with oral steroids?
moderate or severe
83
when should a tx step down be considered in asthma?
if well controlled > 3 months
84
what is the asthma green zone?
2 or fewer day/wk of cough, wheezing or use of SABA
85
what is the asthma yellow zone?
asthma episode, need to consider step up therapy
86
what is the asthma red zone?
cough/wheeze throughout day
SOB at rest or talking
chest sinking in around ribs/neck
SABA use several times/day w/o adequate response
87
what is status asthmaticus?
no response to continuous admin of SABA
88
with what amount of blood loss can BP be maintained?
45%
89
what does the AVPU acronym stand for in assessing disability (D) in trauma?
alertness
voice
pain
unresponsiveness
90
when should an NG or OG tube never be placed?
when you are unsure if there is a fracture
91
what are the components of the secondary trauma eval?
```
Allergies
Medications
PMH
Last meal
Events/environment leading to injury
```
92
poor survival is predicted when asystole persists after what 2 interventions?
1) IV epi x2
| 2) 25min of CPR
93
what is the definition of drowning?
death within 24hrs of event
94
what is the mechanism for drowning?
panic --> hold breath --> insp effort reflex --> hypoxemia --> ischemia
95
what is the difference between the effects of moderate hypothermia and severe hypothermia?
mod - incr O2 consumption
| severe - decr cellular metabolic rate
96
what are the indicators of shock?
1) slow cap refill
2) cool extremities
3) AMS
97
how should glucose abnormalities be treated in the setting of drowning?
hypo - give D5 1/2 NS
| hyper - self limited, do not give insulin if no DM
98
what causes afterdrop?
heating the body starting at the extremities and going toward the core
99
how long should an asx drowning patient be monitored for?
8hrs
100
how long does hypoxemia occur for CNS irreversibility?
3-5min
101
what should be part of the PE in poison case?
MVPs
| mental status, vitals, pupils, skin exam
102
what are the labs for poison case?
```
BEUTEX
blood glucose (rapid)
electrolytes
ABG
UA
tox screen
EKG
XR
```
103
what is used for GI decontamination in GI case?
activated charcoal
104
what is the common pathogen in animal bites?
pasteurella
105
what its the common pathogen in human bites?
Eikenella corrodens
106
what cases warrant primary closure in a bite wound?
1) face
2) uninfected
3) <12 hrs old (<24hrs for face)
107
how much is a 2kg weight loss equivalent to in fluid in terms of dehydration?
2L
108
what is considered severe fluid loss?
> 10%
109
in terms of skin turgor what is considered severely dehydrated?
> 3sec
110
what are the common Na and K abnormalities in dehydration?
hypernatremia and hypokalemia
111
what is the rate of fluid admin in dehydration?
5mL/2min
112
what is the goal of rehydrating?
10mL/kg of body weight for each V/D epidose
113
what is the standard dehydration therapy?
IV crystalloid isotonic saline
114
what does midazolam not provide so much be added?
analgesia
115
what does ketamine provide that midazolam does not?
analgesia (however, more S/E)
116
why is normal saline preferred over sterile water to irrigate a wound?
sterile water can cause hemolysis and more readily absorb in tissue - don't want that
117
what are the leading causes of cancer deaths in kids?
CNS
118
neuroblastoma and wilms tumors are located where?
abdomen
119
what is the most common US cancer in kids?
ALL
120
why is WBC harder to interpret in ALL?
proliferation but non-functioning
121
how is mono different from leukemia in terms of bone marrow?
in mono - atypical lymphocytes in bone marrow
122
what tx is usually required after relapse in AML or ALL?
BMT
123
what is the second most common childhood malignancy?
brain tumor
124
what is the most common solid tumor in kids outside the CNS?
neuroblastoma
125
what is the most common age range for neuroblastoma?
<5 y/o
126
in neuroblastoma, which lab is elevated in most patients?
urinary catecholamines
127
which child with neuroblastoma would have a better prognosis - 2 y/o or 6 y/o?
2 y/o
128
what is the protocol if patient has unilateral wilms tumor?
follow other kidney by US for 8 yrs
129
what is the age range most typical for osteosarcoma?
12-18
130
what is the most common bone affected in osteosarcoma?
distal femur
131
by what age are most retinoblastomas dx?
2 y/o
132
what is the major symptom of retinoblastoma?
leukocoria
133
what is the normal MCV for a child?
70 + age = LLN (for children > 1 y/o)
134
when is jaundice pathological in a baby?
in first 24 hrs of life
135
when does fetal blood most commonly get into maternal blood stream?
third trimester
136
why wouldn't the current pregnancy be affected by an Rh mismatch?
only IgM would be made at first and this does not cross the placenta
137
what is given mom to prevent adverse Rh reaction if she is Rh- and has an Rh+ baby? and how does it work?
anti-D immunoglobulin (Rhogam)
when fetal blood passes into mom - she will already have the ab which will latch to the infant blood and it will destroy before mom can make antibodies
138
what is hydrops fetalis?
presence of at least 2 abnormal fetal fluid collections (ascites, pleural effusion, pericardial effusion, skin edema)
139
what are the 2 most common microcytic anemias?
iron deficiency
| thalassemia minor and major
140
what can elevate ferritin?
infection
141
what is the most common cause of iron deficiency in a toddler?
insufficient dietary iron intake and too much cow's milk
142
how long does iron deficiency anemia need to be treated for?
until labs normalize and then for another 2-3 months
143
how do migraines in kids differ from migraine in adults?
more commonly bilateral in kids whereas unilateral in adults
144
when is a CT preferred for imaging in headache case?
concern for hemorrhage or fracture
145
when is an MRI preferred in a headache case?
to rule out structural intracranial lesions inflammation, ischemia
146
what age must a child be before considered triptans for headache
6 y/o
147
at what point is a triptan considered in a headache?
NSAID use >2-3 days/wk - increased risk for rebound headache
148
what is preventive therapy or headaches in kids?
```
anti epileptics
beta blockers
CCB
antihistamines
antidepressants
TOPIRAMATE
```
149
which type of seizure is more common in children than adults?
generalized
150
what age range is febrile seizures common?
3 month - 6 y/o
151
what is the most common neurological disorder in infants and younger kids?
febrile seizure
152
which vaccines are febrile seizures assoc with?
influenza and DTaP
153
how is status epileptics defined?
at least 5min of continuous seizure activity without regaining consciousness
(may be non-convulsive)
154
what is Broselow tape?
measures height lying down
155
what are the steps to assessing a status epileptics patient?
ABCs, IV access, check blood glucose
156
why is it important to check blood glucose in a status epilepticus patient?
dextrose will stop seizure
157
how many times can a BZ dose be administered to attempt to treat a status epilepticus patient?
3 doses Q5min
158
what is Todd paresis?
postictal neuro deficits that do not go away right away
159
what is epilepsy defined as?
2 or more unprovoked afebrile seizures
160
when is the risk of seizure recurrence highest?
within 2 years of stopping ppx
161
what are the effects of a concussion that occur hours to days later?
mood and cognitive disturbances
sensitivity to light and noise
sleep disturbances
162
when can a concussion patient return to school?
can concentrate on a task and tolerate visual and auditory stimulation for 30-45 min
163
what is the more concerning kind of mottling?
cutis marmorata telangiectasia congenita
164
if mottling doesn't get better with warming what can it indicate?
shock or poor CO
165
what is the pathology underlying erythema toxicum?
eosinophils
166
what is the pathology underlying pustular melanosis?
neutrophils
167
where is pustular melanosis most common on infant?
where the baby presented first
168
what is another name for a slate grey patch?
mongolian spot
169
when are cafe au lait spots concerning?
> 6 spots >5mm (concerning for neurofibromatosis
170
why are large hemangiomas concerning?
can ulcerate
171
what is Sturge-Weber Syndrome?
associated with port wine stains
| patients have only skin but brain and eye involvement (at risk for seizures)
172
what is another name for measles
rubeola
173
when do kids get the measles vaccine?
1 y/o
174
what pathogen causes measles?
paramyxovirus
175
what are Koplik spots associated with?
measles
176
what is a serious complication of measles?
SSPE (subacute sclerosing panenecephalitis)
| progressive CNS degenerative disease
177
what is the clinical diagnosis for mumps?
parotitis and fever
178
what are common sx of rubella in adolescents and adults?
arthritis and arthralgias
179
what is congenital rubella syndrome?
significant disease to fetus if mother catches rubella in first trimester
cataracts, cardiac defects, deafness, HSM, jaundice, blueberry muffin lesions
180
what causes fifth disease (erythema infectiousum)
parvovirus B19
181
what are complications of fifth disease?
aplastic crisis and hydrops fettles if in utero
182
what causes sixth disease (roseola infantum)?
HHV-6
183
what is the classic presentation for 6th disease?
fever followed by rash
184
what is the presentation of erythema herpeticum?
rapid onset fever
| painful eruption of punched out vesicular lesions
185
which disease is associated with a dew drop on a rose petal?
varicella zoster
186
what is the distribution of chicken pox eruption on the body?
starts on trunk, then face, then extremities
187
what causes SSSS
staph a that has spread from blood to skin
188
who is SSSS more common in
kids < 5y/o
189
where does SSSS not affect?
mucous membranes
190
what causes lyme disease?
Borrellia burgdorferi
191
what is the presentation of lyme disease?
erythema migrans (target rash that spreads from bite site)
192
in what disease can Bell's palsy be a complication
Lyme disease
| USU BILATERAL
193
what is a late sign of lyme disease?
arthritis
194
how do fevers differ in kids?
neonates - may not have fever despite serious infection
older infants/young kids - may have exaggerated febrile response
older kids/adolescents - rare to have very high fever
195
how young is too young for ibuprofen?
< 6months
196
what is the MC cause of fever in infants < 28 days old?
Group B strep or E. coli
197
what is a fever of short duration?
fever with localized signs/sx
198
what is a fever without a source?
fever <7 days usu in kids < 3 y/o
199
what is a fever of unknown origin?
fever > 14 days w/o etiology
200
what are the severe sx of AOM and thus require tx?
1) persistent otalgia > 48 hrs
2) temp > 39 in last 48 hrs
3) uncertain access to follow up
201
when would an AOM patient require augmentin?
1) amoxicillin in last 30 days
2) failed initial abx tx
3) concomitant purulent conjunctivitis
202
in what age is more aggressive AOM tx warranted and why?
< 6mon b/c of language acquisition
203
why are abx discouraged in mono?
can cause rash
204
which infection is assoc with halo ulcerations in the posterior pharynx?
hand, foot, mouth
205
when does acute rheumatic fever present in terms of strep?
2-4 wks post infection
206
what lab is usually positive in adult arthritis but negative in JIA?
rheumatoid factor
207
what is the #1 treatable cause of blindness in kids?
uveitis
208
is a fever usually present or absent in pertussis?
absent
209
how is pertussis dx?
PCR and culture
