pysch ad development Flashcards
describe what you should see with motor, language and social for a 24 month old
motor- runs
language- 2-word sentences, several hundred word vocabulary
social- follows 2-step commands
What is the vaccine time line for rotavirus?
first at 2 months, second at 4 months, 3rd at 6 months
a child exhibits short staring spells at school, which are sometimes accompanied by loss of postural tone. Episodes last less than a minute. Electroencephalography reveals bilateral 3-Hz spike-and-wave pattern.
What is the likely Dx?
absence seizure
What is the vaccine time line for Tdap?
First- 2 months second- 4 months third- 6 months fourth- 15-18 months fifth- 4-6 years
Booster starting at 11 years old
describe the kernig sign?
knee extension illicit pain in the neck
What other comorbities is DS associated with?
ALL (acute lymphocytic leukemia)
early onset alzheimer disease
atlantoaxial instability
What is the vaccine time line for Hep B
first shot within 24 hours of birth
second shot 1-2 months later
3rd shot 6-18 months of age
In HBsAg-positive mothers, the infant should receive the hepatitis B vaccine and hepatitis B immune globulin
If a mother is having an ultrasound and it shows nuchal translucency around week 11-14 what is this a sign of?
Down syndrome can also see hypoplastic nasal bone
What is the name for the group of viruses that commonly cause meningitis?
enteroviruses
a 6-month old girl is brought by her father for a scheduled check-up. The patient’s father says they recently started feeding her mushy cereal, which she seems to like but occasionally spits up. He also reports that she has started teething and sometimes becomes “fussy.” Vital signs are within normal limits. You note a happy appearing child with an “open mouth look” and drooling.
likely Dx?
she be teething
low anti-mullerian lab indicates what?
turner syndrome
What is the vaccine time line for PCV-13
first 2 months
second 4
third 6
fourth 12-15 months
Which other viruses can cause meningitis?
herpes simplex virus, HIV, mumps, West Nile virus
A quadruple screen looks at what and is used to Dx what?
this test looks at B-hcg, AFP, estriol and inhibin A
and test for down syndrome
it will show increased B-Hcg and inhibin A
and decreases AFP and estriol
Tx for status epilepticus seizure?
first a benzo then phenytoin
What common organism cause meningitis in immunocompromised pts?
Cryptococcus neoformans
Both the Chorionic villus sampling/amniocentesis test are indicted in what age of the mother?
greater than 35
neonate age is from?
0-3 months
a 10-day-old infant boy is brought to the office for an evaluation. Physical examination shows epicanthal folds, a broad nasal bridge, a large tongue, small ears, hypertelorism, Brushfield spots, a single palmar crease on each hand, and a harsh holosystolic murmur.
What is the likely Dx?
down syndrome
when does teething generally occur?
6-24 months of age
is there a mental status change in meningitis?
nope just in encephalitis
describe what you should see with motor, language and social for a 12 month old?
motor- stands
language- mama/dada
social- picture book
describe what you should see with motor, language and social for a 18 month?
motor- walks upstairs, throws ball
language- names objects
social- toilet training begins
If a child has a febrile seizure and you are suspicious of meningitis what test should you preform?
Lumbar puncture
what is the vaccine time line for Hep A
first 12-24 months
second dose at least 6 months after first
What is a risk factor for increasing odds of having a child with down syndrome?
pregnancy later in life
what are some of the most common signs someone has turner syndrome?
streak ovaries, short stature, lymphedema, neck webbing, and congenital heart and renal defects
what is the Tx for focal, tonic-clonic seizures?
phenytoin, and carbamazepine are drugs of choice
What is the vaccine time line for poliovirus
first 2 months
second 4 months
3rd 6-18 months
fourth 4-6 years
a 3-year-old boy is brought to the emergency department due to a generalized tonic-clonic seizure. The seizure lasted about 3 minutes. His temperature was measured to be 103.2°F. He has no prior history of seizures.
what is the likely Dx?
febrile seizure
When should pts get the HPV shot?
Two doses at 9-14 years of age
in patients between the ages of 9-14, the 2 dose are administered 6-12 months after the first dose
Three doses at ≥ 15 years of age
given at 0, 1-2, and 6 months
For pts greater than 18 when should zoster be given
Two doses given 2-6 months apart at ≥ 50 years of age
At what week of pregnancy can a chorionic villus sample be preformed?
10-12 weeks
When would an amniotic fluid sample be ok to perform? what week of gestation?
week 15
What might be present on physical exam of a patient with turner syndrome?
- amenorrhea with a present uterus
- coarctation of the aorta may be evident on auscultation
- low hairline in back
- low-set ears
- extremity edema
- hypertension
- signs of thyroid dysfunction
- stool guaiac may identify GI bleeding
describe what you should see with motor, language and social for a 6 month infant?
motor- sits up right
language- babbles
social- stranger anxiety
What are the CSF finding on lumbar puncture for meningtisi?
Bacterial: increased Protein decreased Glucose (bacteria love to eat glucose)
describe a status epilepticus seizure?
single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them
What is the diagnostic test of choice?
Karotyping
What is the tx for absence or petit mal seizure?
ethosuximide or valproic acid (depakote)
What is a chorionic villus sampling?
placental tissue sample is retrieved through the cervix and vagina
which teeth are first to appear then followed by what other teeth?
The two bottom front teeth (lower central incisors) are usually the first to appear, followed by the two top front teeth (upper central incisors).
describe what you should see with motor, language and social for a 9 month infant
motor- crawls, pull-to-stand, pincer grasp, eats with fingers
Language- mama/dada nonspecific
social- waves bye bye, responds to name
How do you Tx meningitis?
Dexamethasone + Empiric IV antibiotics (Cephalosporin, Vancomycin, Penicillins)
Household contacts: treat with rifampin, Cipro, Levaquin, azithromycin, ceftriaxone
what type of chromosome is missing in turner syndrome?
a missing X in females 45XO
a 16-year-old female presents for evaluation of delayed onset of menstruation. She is concerned as her friends have all had their first menese. She denies any additional significant PMHx. On physical exam, her temperature is 98.8°F, blood pressure is 114/64 mmHg, pulse is 73/min, and respirations are 13/min. The patient is short statured, has a short neck and wide torso. You note webbing skin between the neck and shoulders. She has Tanner stage I breast development and pubic hair with normal external female genitalia. On bimanual exam, the vagina is of normal length and the cervix is palpable.
Likely Dx?
turner syndrome
How do you treat turner syndrome?
growth hormone therapy and sex hormone replacement therapy.
What is the vaccine time line for flu?
annually once older than 6 months
When should adolescents get the meningococcal vaccine?
first at 11-12 years
second at 16
at what age should honey be introduced to an infant?
1 year old
what age range do febrile seizures usually occur?
6 months to 5 years
What is the Tx for meningitis caused by a virus? or HSV?
symptomatic or IV acyclovir for HSV
describe brudzinki sign?
leg raises when neck is flexed
What is the vaccine time line for MMR?
First dose at 12-15 months
Second dose at 4-6 years of age
what is the classic triad of meningitis?
Headache, fever and nuchal rigidity
What are some of the biggest risk factors a pt with DS has? like future medical problems
Septal defects between atria
Duodenal atresia
Increased risk for acute lymphoblastic leukemia
Mental retardation and an increased risk for Alzheimer disease
Sterility in males
What are some risk factors to having a febrile seizure?
Age – potentially due to developing nervous system being vulnerable to fever
Viral infection (i.e., HHV-6, Influenza virus)
Family history – potential genetic component
Recent immunizations – the absolute risk is small
What are two prenatal lab test/exams can you do to diagnose down syndrome?
Chorionic villus sampling/amniocentesis
a 10-month-old boy presents to the ED for several days of irritability and poor feeding. The patient has no significant past medical history and has received all routine preventative care. His temperature is 102.5°F, blood pressure is 57/40 mmHg, pulse is 172/min, respirations are 34/min, and oxygen saturation is 98% on room air. During the exam the infant is irritable and is crying. Musculoskeletal exam reveals that the patient’s knee can not be extended while the patient’s hip is in a flexed position without significant patient irritation. The rest of the exam is within normal limits.
what is the likely Dx?
meningitis
describe what you should see with motor, language and social for a 4 month infant
Motor- rolls from prone to supine, grasps objects
Language- orients to voice, colic resolves in most
social- laughs
describe what you should see with motor, language and social for a infant 3 months
3 months- lifts head and neck. Moro reflex goes away
Endoscopy of someone with turner syndrome might find what?
may identify GI telangiectasias causing lower GI bleeding
What vaccine should be given in pregnant women every time they are prego and around weeks 27-36
Tdap
what common organisms cause meningitis in most people?
S. pneumoniae (gram-positive diplococci), N. meningitidis (gram-negative diplococci)
What is the vaccine time line for H. influenzae type b conjugate
First dose at 2 months
Second dose at 4 months
Third dose at 12-15 months
what is postictal state?
confusion and loss of memory
how do you Dx meningitis?
spinal tab!!!
If the febrile seizure lasts for longer than 5 minutes what can you use to treat it?
benzodiazepine
What common organisms cause meningitis in neonate
E. coli (gram-negative rods) and S. agalactiae (Group B Streptococcus)
What will a focal seizure with loss of awareness present with that makes it different than absence seizure?
postictal state
can most patients with turner syndrome have kids?
no, most are infertile
describe what you should see with motor, language and social for a neonate?
Motor- Moro and grasp reflex, visual tracking
Language- crying
social- minimal
describe what you should see with motor, language and social for a 15 month old
motor- walks uses cups
language- several words
social- temper tantrums
