Peds Final Flashcards
what is the definition of delayed puberty in females?
no thelarche by age 13
what is considered precocious puberty in girls?
SMR 2 < 8 y/o
what is an abnormally long period of time between thelarche and menarche?
> 3-5 years
what is considered precocious puberty in boys?
SMR 2 < 9 y/o
what age is considered delayed puberty in males?
no testicular growth by age 14
at what age do providers usually start talking to kids alone?
11-12
when should the sex talk happen?
5th or 6th grade to delay coitarche
how many adolescents report using alcohol by the 10th grade?
50%
how many adolescents report being drunk at least once in high school?
50%
how many adolescents have tried marijuana in high school?
44%
when is growth hormone irrelevant?
1st year of life
when should insulin be started in a child presenting with DMII?
ketones and glucose > 300mg/dL
what is considered overweight in children?
> 85%-95%
what is considered obese in children?
> 95%
what is the 5-2-1-0 rule for obesity in kids?
5 servings fruits/veggies
2 hrs screen time
1 hour physical activity
0 sweetened beverages
when is strabismus normal?
< 4months (esodeviations)
when can you just observe AOM?
1) unilateral AOM w/o otorrhea 6-2 y/o
2) unilateral or bilateral AOM w/o otorrhea >2yrs
when is follow-up required for AOM? and when?
when doing observation (48-72 hrs)
when is fever typically high with infection and is not too concerning?
first 6 yrs of life
what is the most common cause of URI?
rhinovirus
what age range is it recommended that cough medication be avoided?
<6
what has shown affect over placebo for cough?
honey (>1 y/o)
how long is the typical URI?
7-9 days
dx criteria for acute bacterial sinusitis (need 1)
1) sx present for >10 days
2) sx worsen w/new onset of fever or cough
3) associated w/temps >39C > 3 days
when is the earliest allergic rhinitis tends to appear?
10-12 months
when do seasonal allergies typically appear?
3-4 y/o
what are antihistamines not really effective for?
congestion and postnasal drip
where does most epistaxis originate from?
Kiesselbach area
4 keys mono sx
1) tonsillar exudates
2) cervical LAD (more often posterior)
3) fever
4) +/- spleen enlarged
hand, foot, mouth sx
1) posterior pharynx ulcerations
2) maculopapular or vesicular rash on hands and feet
what is the Centor 4 point scale used for?
strep
the more points, the more likely it is strep
what is included in the Centor 4 point scale
1) fever
2) absence of cough
3) anterior cervical adenopathy
4) tonsillar exudates
how many criteria of the Centor 4 point scale should a patient meet in order to be strep tested?
3
what is scarlet fever?
strep with a rash (may have strawberry tongue)
PANDAS
subset of kids that get OCD or ticks after having strep
what is the Brodsky scale?
measure how much of oropharynx is taken up by the tonsils
what are the sx of acute rheumatic fever?
1) arthritis
2) carditis and valvulitis
3) CNS involvement
4) erythema marginatum
5) subcutaneous nodules
when is croup most common?
6-36 months
how is croup spread?
direct contact, droplets, fomites
what are the primary causes of croup?
parainfluenza type 1 & 2
what is the barking cough associated with?
croup
what distinguishes croup from epiglottitis?
presence of cough & absence of drooling
when is epiglottitis most common?
2-6 y/o
in what condition does the thumbprint sign appear on neck XR?
epiglottitis
when are the peaks for JIA?
1-3
8-12
what is the timeframe necessary to dx JIA?
> 6 weeks
what is Still’s disease?
systemic JIA (inflammation preceding onset of arthritis
rheumatoid factor in JIA
negative
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
what is the remission rate of JIA proportional to?
the # of joints involved
what are the skin manifestations of JDM?
1) heliotrope rash
2) Gottron’s papules
3) periungual erythema
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
which MSK dz causes large LE joints?
HSP
what is the characteristic lab finding in HSP?
leukocytoclastic vasculitis with IgA deposition
what must patients not have in HSP?
thrombocytopenia
what ages can use the pavlik harness for DDH?
0-6 mon
what are the 2 signs of DDH?
1) asymmetrical creases
2) Galeazzi sign
is DDH more often unilateral or bilateral?
unilateral (L>R)
what are the PE tests involved in DDH?
Barlow (dislocation) and Ortolani (reduction)
what movement is decreased in avascular necrosis of the femoral head?
internal rotation and abduction
what can be seen on film in late avascular necrosis?
flattening of femoral head
internal femoral torsion is more common in which age group?
> 2y/o
internal tibial torsion is more common in which age group?
<2 y/o
when do genu varum and genu valgum usually resolve by?
5-8 y/o
what is the most common polydactyly?
fusion
what is a mild scoliosis curve?
10-30 degrees
what age group is susceptible to nursemaid’s elbow?
<5 y/o
when is a nursemaid’s elbow painful?
with activity
how does child hold arm with nursemaid’s elbow?
pronated and held close to body with elbow extended or slightly flexed
how is bronchiolitis dx?
clinically
what is the MC cause of bronchiolitis?
RSV
what should infants receive if they are at increased risk airway obstruction w/bronchiolitis?
Synagis (palivizumab) monthly
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
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)
what tests are used for pertussis dx?
PCR and culture
what is the real point of treating pertussis?
limiting spread
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
how old is old enough to dx asthma?
long enough to have had at least 4 recurrent episodes
how is asthma dx?
spirometry - incr FEV1 of >200mL and 12% from baseline after take SABA
at what age is spirometry reliable?
5 y/o
what is the tx for exercise induced asthma?
pre-tx w/albuterol 2 puffs at least 15min prior to exercise
which classifications of asthma should be treated with oral steroids?
moderate or severe
when should a tx step down be considered in asthma?
if well controlled > 3 months
what is the asthma green zone?
2 or fewer day/wk of cough, wheezing or use of SABA
what is the asthma yellow zone?
asthma episode, need to consider step up therapy
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
what is status asthmaticus?
no response to continuous admin of SABA
with what amount of blood loss can BP be maintained?
45%
what does the AVPU acronym stand for in assessing disability (D) in trauma?
alertness
voice
pain
unresponsiveness
when should an NG or OG tube never be placed?
when you are unsure if there is a fracture
what are the components of the secondary trauma eval?
Allergies Medications PMH Last meal Events/environment leading to injury
poor survival is predicted when asystole persists after what 2 interventions?
1) IV epi x2
2) 25min of CPR
what is the definition of drowning?
death within 24hrs of event
what is the mechanism for drowning?
panic –> hold breath –> insp effort reflex –> hypoxemia –> ischemia
what is the difference between the effects of moderate hypothermia and severe hypothermia?
mod - incr O2 consumption
severe - decr cellular metabolic rate
what are the indicators of shock?
1) slow cap refill
2) cool extremities
3) AMS
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
what causes afterdrop?
heating the body starting at the extremities and going toward the core
how long should an asx drowning patient be monitored for?
8hrs
how long does hypoxemia occur for CNS irreversibility?
3-5min
what should be part of the PE in poison case?
MVPs
mental status, vitals, pupils, skin exam
what are the labs for poison case?
BEUTEX blood glucose (rapid) electrolytes ABG UA tox screen EKG XR
what is used for GI decontamination in GI case?
activated charcoal
what is the common pathogen in animal bites?
pasteurella
what its the common pathogen in human bites?
Eikenella corrodens
what cases warrant primary closure in a bite wound?
1) face
2) uninfected
3) <12 hrs old (<24hrs for face)
how much is a 2kg weight loss equivalent to in fluid in terms of dehydration?
2L
what is considered severe fluid loss?
> 10%
in terms of skin turgor what is considered severely dehydrated?
> 3sec
what are the common Na and K abnormalities in dehydration?
hypernatremia and hypokalemia
what is the rate of fluid admin in dehydration?
5mL/2min
what is the goal of rehydrating?
10mL/kg of body weight for each V/D epidose
what is the standard dehydration therapy?
IV crystalloid isotonic saline
what does midazolam not provide so much be added?
analgesia
what does ketamine provide that midazolam does not?
analgesia (however, more S/E)
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
what are the leading causes of cancer deaths in kids?
CNS
neuroblastoma and wilms tumors are located where?
abdomen
what is the most common US cancer in kids?
ALL
why is WBC harder to interpret in ALL?
proliferation but non-functioning
how is mono different from leukemia in terms of bone marrow?
in mono - atypical lymphocytes in bone marrow
what tx is usually required after relapse in AML or ALL?
BMT
what is the second most common childhood malignancy?
brain tumor
what is the most common solid tumor in kids outside the CNS?
neuroblastoma
what is the most common age range for neuroblastoma?
<5 y/o
in neuroblastoma, which lab is elevated in most patients?
urinary catecholamines
which child with neuroblastoma would have a better prognosis - 2 y/o or 6 y/o?
2 y/o
what is the protocol if patient has unilateral wilms tumor?
follow other kidney by US for 8 yrs
what is the age range most typical for osteosarcoma?
12-18
what is the most common bone affected in osteosarcoma?
distal femur
by what age are most retinoblastomas dx?
2 y/o
what is the major symptom of retinoblastoma?
leukocoria
what is the normal MCV for a child?
70 + age = LLN (for children > 1 y/o)
when is jaundice pathological in a baby?
in first 24 hrs of life
when does fetal blood most commonly get into maternal blood stream?
third trimester
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
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
what is hydrops fetalis?
presence of at least 2 abnormal fetal fluid collections (ascites, pleural effusion, pericardial effusion, skin edema)
what are the 2 most common microcytic anemias?
iron deficiency
thalassemia minor and major
what can elevate ferritin?
infection
what is the most common cause of iron deficiency in a toddler?
insufficient dietary iron intake and too much cow’s milk
how long does iron deficiency anemia need to be treated for?
until labs normalize and then for another 2-3 months
how do migraines in kids differ from migraine in adults?
more commonly bilateral in kids whereas unilateral in adults
when is a CT preferred for imaging in headache case?
concern for hemorrhage or fracture
when is an MRI preferred in a headache case?
to rule out structural intracranial lesions inflammation, ischemia
what age must a child be before considered triptans for headache
6 y/o
at what point is a triptan considered in a headache?
NSAID use >2-3 days/wk - increased risk for rebound headache
what is preventive therapy or headaches in kids?
anti epileptics beta blockers CCB antihistamines antidepressants TOPIRAMATE
which type of seizure is more common in children than adults?
generalized
what age range is febrile seizures common?
3 month - 6 y/o
what is the most common neurological disorder in infants and younger kids?
febrile seizure
which vaccines are febrile seizures assoc with?
influenza and DTaP
how is status epileptics defined?
at least 5min of continuous seizure activity without regaining consciousness
(may be non-convulsive)
what is Broselow tape?
measures height lying down
what are the steps to assessing a status epileptics patient?
ABCs, IV access, check blood glucose
why is it important to check blood glucose in a status epilepticus patient?
dextrose will stop seizure
how many times can a BZ dose be administered to attempt to treat a status epilepticus patient?
3 doses Q5min
what is Todd paresis?
postictal neuro deficits that do not go away right away
what is epilepsy defined as?
2 or more unprovoked afebrile seizures
when is the risk of seizure recurrence highest?
within 2 years of stopping ppx
what are the effects of a concussion that occur hours to days later?
mood and cognitive disturbances
sensitivity to light and noise
sleep disturbances
when can a concussion patient return to school?
can concentrate on a task and tolerate visual and auditory stimulation for 30-45 min
what is the more concerning kind of mottling?
cutis marmorata telangiectasia congenita
if mottling doesn’t get better with warming what can it indicate?
shock or poor CO
what is the pathology underlying erythema toxicum?
eosinophils
what is the pathology underlying pustular melanosis?
neutrophils
where is pustular melanosis most common on infant?
where the baby presented first
what is another name for a slate grey patch?
mongolian spot
when are cafe au lait spots concerning?
> 6 spots >5mm (concerning for neurofibromatosis
why are large hemangiomas concerning?
can ulcerate
what is Sturge-Weber Syndrome?
associated with port wine stains
patients have only skin but brain and eye involvement (at risk for seizures)
what is another name for measles
rubeola
when do kids get the measles vaccine?
1 y/o
what pathogen causes measles?
paramyxovirus
what are Koplik spots associated with?
measles
what is a serious complication of measles?
SSPE (subacute sclerosing panenecephalitis)
progressive CNS degenerative disease
what is the clinical diagnosis for mumps?
parotitis and fever
what are common sx of rubella in adolescents and adults?
arthritis and arthralgias
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
what causes fifth disease (erythema infectiousum)
parvovirus B19
what are complications of fifth disease?
aplastic crisis and hydrops fettles if in utero
what causes sixth disease (roseola infantum)?
HHV-6
what is the classic presentation for 6th disease?
fever followed by rash
what is the presentation of erythema herpeticum?
rapid onset fever
painful eruption of punched out vesicular lesions
which disease is associated with a dew drop on a rose petal?
varicella zoster
what is the distribution of chicken pox eruption on the body?
starts on trunk, then face, then extremities
what causes SSSS
staph a that has spread from blood to skin
who is SSSS more common in
kids < 5y/o
where does SSSS not affect?
mucous membranes
what causes lyme disease?
Borrellia burgdorferi
what is the presentation of lyme disease?
erythema migrans (target rash that spreads from bite site)
in what disease can Bell’s palsy be a complication
Lyme disease
USU BILATERAL
what is a late sign of lyme disease?
arthritis
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
how young is too young for ibuprofen?
< 6months
what is the MC cause of fever in infants < 28 days old?
Group B strep or E. coli
what is a fever of short duration?
fever with localized signs/sx
what is a fever without a source?
fever <7 days usu in kids < 3 y/o
what is a fever of unknown origin?
fever > 14 days w/o etiology
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
when would an AOM patient require augmentin?
1) amoxicillin in last 30 days
2) failed initial abx tx
3) concomitant purulent conjunctivitis
in what age is more aggressive AOM tx warranted and why?
< 6mon b/c of language acquisition
why are abx discouraged in mono?
can cause rash
which infection is assoc with halo ulcerations in the posterior pharynx?
hand, foot, mouth
when does acute rheumatic fever present in terms of strep?
2-4 wks post infection
what lab is usually positive in adult arthritis but negative in JIA?
rheumatoid factor
what is the #1 treatable cause of blindness in kids?
uveitis
is a fever usually present or absent in pertussis?
absent
how is pertussis dx?
PCR and culture
