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Clin Med/Spec > Peds Final > Flashcards

Peds Final Flashcards

1
Q

what is the definition of delayed puberty in females?

A

no thelarche by age 13

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2
Q

what is considered precocious puberty in girls?

A

SMR 2 < 8 y/o

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3
Q

what is an abnormally long period of time between thelarche and menarche?

A

> 3-5 years

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4
Q

what is considered precocious puberty in boys?

A

SMR 2 < 9 y/o

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5
Q

what age is considered delayed puberty in males?

A

no testicular growth by age 14

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6
Q

at what age do providers usually start talking to kids alone?

A

11-12

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7
Q

when should the sex talk happen?

A

5th or 6th grade to delay coitarche

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8
Q

how many adolescents report using alcohol by the 10th grade?

A

50%

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9
Q

how many adolescents report being drunk at least once in high school?

A

50%

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10
Q

how many adolescents have tried marijuana in high school?

A

44%

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11
Q

when is growth hormone irrelevant?

A

1st year of life

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12
Q

when should insulin be started in a child presenting with DMII?

A

ketones and glucose > 300mg/dL

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13
Q

what is considered overweight in children?

A

> 85%-95%

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14
Q

what is considered obese in children?

A

> 95%

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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

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16
Q

when is strabismus normal?

A

< 4months (esodeviations)

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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

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18
Q

when is follow-up required for AOM? and when?

A

when doing observation (48-72 hrs)

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19
Q

when is fever typically high with infection and is not too concerning?

A

first 6 yrs of life

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20
Q

what is the most common cause of URI?

A

rhinovirus

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21
Q

what age range is it recommended that cough medication be avoided?

A

<6

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22
Q

what has shown affect over placebo for cough?

A

honey (>1 y/o)

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23
Q

how long is the typical URI?

A

7-9 days

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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

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25
Q

when is the earliest allergic rhinitis tends to appear?

A

10-12 months

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26
Q

when do seasonal allergies typically appear?

A

3-4 y/o

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27
Q

what are antihistamines not really effective for?

A

congestion and postnasal drip

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28
Q

where does most epistaxis originate from?

A

Kiesselbach area

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29
Q

4 keys mono sx

A

1) tonsillar exudates
2) cervical LAD (more often posterior)
3) fever
4) +/- spleen enlarged

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30
Q

hand, foot, mouth sx

A

1) posterior pharynx ulcerations

2) maculopapular or vesicular rash on hands and feet

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31
Q

what is the Centor 4 point scale used for?

A

strep

the more points, the more likely it is strep

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32
Q

what is included in the Centor 4 point scale

A

1) fever
2) absence of cough
3) anterior cervical adenopathy
4) tonsillar exudates

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33
Q

how many criteria of the Centor 4 point scale should a patient meet in order to be strep tested?

A

3

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34
Q

what is scarlet fever?

A

strep with a rash (may have strawberry tongue)

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35
Q

PANDAS

A

subset of kids that get OCD or ticks after having strep

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36
Q

what is the Brodsky scale?

A

measure how much of oropharynx is taken up by the tonsils

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37
Q

what are the sx of acute rheumatic fever?

A

1) arthritis
2) carditis and valvulitis
3) CNS involvement
4) erythema marginatum
5) subcutaneous nodules

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38
Q

when is croup most common?

A

6-36 months

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39
Q

how is croup spread?

A

direct contact, droplets, fomites

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40
Q

what are the primary causes of croup?

A

parainfluenza type 1 & 2

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41
Q

what is the barking cough associated with?

A

croup

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42
Q

what distinguishes croup from epiglottitis?

A

presence of cough & absence of drooling

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43
Q

when is epiglottitis most common?

A

2-6 y/o

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44
Q

in what condition does the thumbprint sign appear on neck XR?

A

epiglottitis

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45
Q

when are the peaks for JIA?

A

1-3

8-12

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46
Q

what is the timeframe necessary to dx JIA?

A

> 6 weeks

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47
Q

what is Still’s disease?

A

systemic JIA (inflammation preceding onset of arthritis

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48
Q

rheumatoid factor in JIA

A

negative

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49
Q

what screening is required in all patient with JIA? why?

A

uveitis because it is a common complication and can be asx but lead to blindness

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50
Q

what is the remission rate of JIA proportional to?

A

the # of joints involved

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51
Q

what are the skin manifestations of JDM?

A

1) heliotrope rash
2) Gottron’s papules
3) periungual erythema

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52
Q

what is Gower’s sign? which disease is it seen in?

A

when prone, get into downward dog and walk body up due to muscle weakness
JDM

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53
Q

which MSK dz causes large LE joints?

A

HSP

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54
Q

what is the characteristic lab finding in HSP?

A

leukocytoclastic vasculitis with IgA deposition

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55
Q

what must patients not have in HSP?

A

thrombocytopenia

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56
Q

what ages can use the pavlik harness for DDH?

A

0-6 mon

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57
Q

what are the 2 signs of DDH?

A

1) asymmetrical creases

2) Galeazzi sign

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58
Q

is DDH more often unilateral or bilateral?

A

unilateral (L>R)

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59
Q

what are the PE tests involved in DDH?

A

Barlow (dislocation) and Ortolani (reduction)

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60
Q

what movement is decreased in avascular necrosis of the femoral head?

A

internal rotation and abduction

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61
Q

what can be seen on film in late avascular necrosis?

A

flattening of femoral head

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62
Q

internal femoral torsion is more common in which age group?

A

> 2y/o

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63
Q

internal tibial torsion is more common in which age group?

A

<2 y/o

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64
Q

when do genu varum and genu valgum usually resolve by?

A

5-8 y/o

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65
Q

what is the most common polydactyly?

A

fusion

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66
Q

what is a mild scoliosis curve?

A

10-30 degrees

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67
Q

what age group is susceptible to nursemaid’s elbow?

A

<5 y/o

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68
Q

when is a nursemaid’s elbow painful?

A

with activity

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69
Q

how does child hold arm with nursemaid’s elbow?

A

pronated and held close to body with elbow extended or slightly flexed

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70
Q

how is bronchiolitis dx?

A

clinically

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71
Q

what is the MC cause of bronchiolitis?

A

RSV

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72
Q

what should infants receive if they are at increased risk airway obstruction w/bronchiolitis?

A

Synagis (palivizumab) monthly

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73
Q

which infants specifically should receive pavilizumab as ppx?

A

1) infants born premature
2) <12 mon at onset of RSV season
3) chronic lung disease of prematurity

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74
Q

what are the 3 stages of pertussis?

A

1) catarrhal - cough + rhinorrhea (1-2wks)
2) paroxysmal - whooping cough and emesis (2-8wks)
3) convalescent - gradual waning of sx (wks-mons)

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75
Q

what tests are used for pertussis dx?

A

PCR and culture

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76
Q

what is the real point of treating pertussis?

A

limiting spread

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77
Q

what is the difference between the clinical presentations of viral and bacterial PNA?

A

viral - cough, wheezing, URI sx

bacterial - high fever, chills, cough, dyspnea, focal lung findings

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78
Q

how old is old enough to dx asthma?

A

long enough to have had at least 4 recurrent episodes

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79
Q

how is asthma dx?

A

spirometry - incr FEV1 of >200mL and 12% from baseline after take SABA

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80
Q

at what age is spirometry reliable?

A

5 y/o

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81
Q

what is the tx for exercise induced asthma?

A

pre-tx w/albuterol 2 puffs at least 15min prior to exercise

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82
Q

which classifications of asthma should be treated with oral steroids?

A

moderate or severe

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83
Q

when should a tx step down be considered in asthma?

A

if well controlled > 3 months

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84
Q

what is the asthma green zone?

A

2 or fewer day/wk of cough, wheezing or use of SABA

85
Q

what is the asthma yellow zone?

A

asthma episode, need to consider step up therapy

86
Q

what is the asthma red zone?

A

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
Q

what is status asthmaticus?

A

no response to continuous admin of SABA

88
Q

with what amount of blood loss can BP be maintained?

A

45%

89
Q

what does the AVPU acronym stand for in assessing disability (D) in trauma?

A

alertness
voice
pain
unresponsiveness

90
Q

when should an NG or OG tube never be placed?

A

when you are unsure if there is a fracture

91
Q

what are the components of the secondary trauma eval?

A 
Allergies
Medications
PMH
Last meal 
Events/environment leading to injury
92
Q

poor survival is predicted when asystole persists after what 2 interventions?

A

1) IV epi x2

2) 25min of CPR

93
Q

what is the definition of drowning?

A

death within 24hrs of event

94
Q

what is the mechanism for drowning?

A

panic –> hold breath –> insp effort reflex –> hypoxemia –> ischemia

95
Q

what is the difference between the effects of moderate hypothermia and severe hypothermia?

A

mod - incr O2 consumption

severe - decr cellular metabolic rate

96
Q

what are the indicators of shock?

A

1) slow cap refill
2) cool extremities
3) AMS

97
Q

how should glucose abnormalities be treated in the setting of drowning?

A

hypo - give D5 1/2 NS

hyper - self limited, do not give insulin if no DM

98
Q

what causes afterdrop?

A

heating the body starting at the extremities and going toward the core

99
Q

how long should an asx drowning patient be monitored for?

A

8hrs

100
Q

how long does hypoxemia occur for CNS irreversibility?

A

3-5min

101
Q

what should be part of the PE in poison case?

A

MVPs

mental status, vitals, pupils, skin exam

102
Q

what are the labs for poison case?

A 
BEUTEX
blood glucose (rapid) 
electrolytes
ABG
UA
tox screen
EKG
XR
103
Q

what is used for GI decontamination in GI case?

A

activated charcoal

104
Q

what is the common pathogen in animal bites?

A

pasteurella

105
Q

what its the common pathogen in human bites?

A

Eikenella corrodens

106
Q

what cases warrant primary closure in a bite wound?

A

1) face
2) uninfected
3) <12 hrs old (<24hrs for face)

107
Q

how much is a 2kg weight loss equivalent to in fluid in terms of dehydration?

A

2L

108
Q

what is considered severe fluid loss?

A

> 10%

109
Q

in terms of skin turgor what is considered severely dehydrated?

A

> 3sec

110
Q

what are the common Na and K abnormalities in dehydration?

A

hypernatremia and hypokalemia

111
Q

what is the rate of fluid admin in dehydration?

A

5mL/2min

112
Q

what is the goal of rehydrating?

A

10mL/kg of body weight for each V/D epidose

113
Q

what is the standard dehydration therapy?

A

IV crystalloid isotonic saline

114
Q

what does midazolam not provide so much be added?

A

analgesia

115
Q

what does ketamine provide that midazolam does not?

A

analgesia (however, more S/E)

116
Q

why is normal saline preferred over sterile water to irrigate a wound?

A

sterile water can cause hemolysis and more readily absorb in tissue - don’t want that

117
Q

what are the leading causes of cancer deaths in kids?

A

CNS

118
Q

neuroblastoma and wilms tumors are located where?

A

abdomen

119
Q

what is the most common US cancer in kids?

A

ALL

120
Q

why is WBC harder to interpret in ALL?

A

proliferation but non-functioning

121
Q

how is mono different from leukemia in terms of bone marrow?

A

in mono - atypical lymphocytes in bone marrow

122
Q

what tx is usually required after relapse in AML or ALL?

A

BMT

123
Q

what is the second most common childhood malignancy?

A

brain tumor

124
Q

what is the most common solid tumor in kids outside the CNS?

A

neuroblastoma

125
Q

what is the most common age range for neuroblastoma?

A

<5 y/o

126
Q

in neuroblastoma, which lab is elevated in most patients?

A

urinary catecholamines

127
Q

which child with neuroblastoma would have a better prognosis - 2 y/o or 6 y/o?

A

2 y/o

128
Q

what is the protocol if patient has unilateral wilms tumor?

A

follow other kidney by US for 8 yrs

129
Q

what is the age range most typical for osteosarcoma?

A

12-18

130
Q

what is the most common bone affected in osteosarcoma?

A

distal femur

131
Q

by what age are most retinoblastomas dx?

A

2 y/o

132
Q

what is the major symptom of retinoblastoma?

A

leukocoria

133
Q

what is the normal MCV for a child?

A

70 + age = LLN (for children > 1 y/o)

134
Q

when is jaundice pathological in a baby?

A

in first 24 hrs of life

135
Q

when does fetal blood most commonly get into maternal blood stream?

A

third trimester

136
Q

why wouldn’t the current pregnancy be affected by an Rh mismatch?

A

only IgM would be made at first and this does not cross the placenta

137
Q

what is given mom to prevent adverse Rh reaction if she is Rh- and has an Rh+ baby? and how does it work?

A

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
Q

what is hydrops fetalis?

A

presence of at least 2 abnormal fetal fluid collections (ascites, pleural effusion, pericardial effusion, skin edema)

139
Q

what are the 2 most common microcytic anemias?

A

iron deficiency

thalassemia minor and major

140
Q

what can elevate ferritin?

A

infection

141
Q

what is the most common cause of iron deficiency in a toddler?

A

insufficient dietary iron intake and too much cow’s milk

142
Q

how long does iron deficiency anemia need to be treated for?

A

until labs normalize and then for another 2-3 months

143
Q

how do migraines in kids differ from migraine in adults?

A

more commonly bilateral in kids whereas unilateral in adults

144
Q

when is a CT preferred for imaging in headache case?

A

concern for hemorrhage or fracture

145
Q

when is an MRI preferred in a headache case?

A

to rule out structural intracranial lesions inflammation, ischemia

146
Q

what age must a child be before considered triptans for headache

A

6 y/o

147
Q

at what point is a triptan considered in a headache?

A

NSAID use >2-3 days/wk - increased risk for rebound headache

148
Q

what is preventive therapy or headaches in kids?

A 
anti epileptics
beta blockers
CCB
antihistamines
antidepressants
TOPIRAMATE
149
Q

which type of seizure is more common in children than adults?

A

generalized

150
Q

what age range is febrile seizures common?

A

3 month - 6 y/o

151
Q

what is the most common neurological disorder in infants and younger kids?

A

febrile seizure

152
Q

which vaccines are febrile seizures assoc with?

A

influenza and DTaP

153
Q

how is status epileptics defined?

A

at least 5min of continuous seizure activity without regaining consciousness
(may be non-convulsive)

154
Q

what is Broselow tape?

A

measures height lying down

155
Q

what are the steps to assessing a status epileptics patient?

A

ABCs, IV access, check blood glucose

156
Q

why is it important to check blood glucose in a status epilepticus patient?

A

dextrose will stop seizure

157
Q

how many times can a BZ dose be administered to attempt to treat a status epilepticus patient?

A

3 doses Q5min

158
Q

what is Todd paresis?

A

postictal neuro deficits that do not go away right away

159
Q

what is epilepsy defined as?

A

2 or more unprovoked afebrile seizures

160
Q

when is the risk of seizure recurrence highest?

A

within 2 years of stopping ppx

161
Q

what are the effects of a concussion that occur hours to days later?

A

mood and cognitive disturbances
sensitivity to light and noise
sleep disturbances

162
Q

when can a concussion patient return to school?

A

can concentrate on a task and tolerate visual and auditory stimulation for 30-45 min

163
Q

what is the more concerning kind of mottling?

A

cutis marmorata telangiectasia congenita

164
Q

if mottling doesn’t get better with warming what can it indicate?

A

shock or poor CO

165
Q

what is the pathology underlying erythema toxicum?

A

eosinophils

166
Q

what is the pathology underlying pustular melanosis?

A

neutrophils

167
Q

where is pustular melanosis most common on infant?

A

where the baby presented first

168
Q

what is another name for a slate grey patch?

A

mongolian spot

169
Q

when are cafe au lait spots concerning?

A

> 6 spots >5mm (concerning for neurofibromatosis

170
Q

why are large hemangiomas concerning?

A

can ulcerate

171
Q

what is Sturge-Weber Syndrome?

A

associated with port wine stains

patients have only skin but brain and eye involvement (at risk for seizures)

172
Q

what is another name for measles

A

rubeola

173
Q

when do kids get the measles vaccine?

A

1 y/o

174
Q

what pathogen causes measles?

A

paramyxovirus

175
Q

what are Koplik spots associated with?

A

measles

176
Q

what is a serious complication of measles?

A

SSPE (subacute sclerosing panenecephalitis)

progressive CNS degenerative disease

177
Q

what is the clinical diagnosis for mumps?

A

parotitis and fever

178
Q

what are common sx of rubella in adolescents and adults?

A

arthritis and arthralgias

179
Q

what is congenital rubella syndrome?

A

significant disease to fetus if mother catches rubella in first trimester
cataracts, cardiac defects, deafness, HSM, jaundice, blueberry muffin lesions

180
Q

what causes fifth disease (erythema infectiousum)

A

parvovirus B19

181
Q

what are complications of fifth disease?

A

aplastic crisis and hydrops fettles if in utero

182
Q

what causes sixth disease (roseola infantum)?

A

HHV-6

183
Q

what is the classic presentation for 6th disease?

A

fever followed by rash

184
Q

what is the presentation of erythema herpeticum?

A

rapid onset fever

painful eruption of punched out vesicular lesions

185
Q

which disease is associated with a dew drop on a rose petal?

A

varicella zoster

186
Q

what is the distribution of chicken pox eruption on the body?

A

starts on trunk, then face, then extremities

187
Q

what causes SSSS

A

staph a that has spread from blood to skin

188
Q

who is SSSS more common in

A

kids < 5y/o

189
Q

where does SSSS not affect?

A

mucous membranes

190
Q

what causes lyme disease?

A

Borrellia burgdorferi

191
Q

what is the presentation of lyme disease?

A

erythema migrans (target rash that spreads from bite site)

192
Q

in what disease can Bell’s palsy be a complication

A

Lyme disease

USU BILATERAL

193
Q

what is a late sign of lyme disease?

A

arthritis

194
Q

how do fevers differ in kids?

A

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
Q

how young is too young for ibuprofen?

A

< 6months

196
Q

what is the MC cause of fever in infants < 28 days old?

A

Group B strep or E. coli

197
Q

what is a fever of short duration?

A

fever with localized signs/sx

198
Q

what is a fever without a source?

A

fever <7 days usu in kids < 3 y/o

199
Q

what is a fever of unknown origin?

A

fever > 14 days w/o etiology

200
Q

what are the severe sx of AOM and thus require tx?

A

1) persistent otalgia > 48 hrs
2) temp > 39 in last 48 hrs
3) uncertain access to follow up

201
Q

when would an AOM patient require augmentin?

A

1) amoxicillin in last 30 days
2) failed initial abx tx
3) concomitant purulent conjunctivitis

202
Q

in what age is more aggressive AOM tx warranted and why?

A

< 6mon b/c of language acquisition

203
Q

why are abx discouraged in mono?

A

can cause rash

204
Q

which infection is assoc with halo ulcerations in the posterior pharynx?

A

hand, foot, mouth

205
Q

when does acute rheumatic fever present in terms of strep?

A

2-4 wks post infection

206
Q

what lab is usually positive in adult arthritis but negative in JIA?

A

rheumatoid factor

207
Q

what is the #1 treatable cause of blindness in kids?

A

uveitis

208
Q

is a fever usually present or absent in pertussis?

A

absent

209
Q

how is pertussis dx?

A

PCR and culture

Clin Med/Spec (11 decks)

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