Section 6: Pediatrics 2 Flashcards
List the effects of the following drugs on the neonate
- Anesthetics
- Barbiturates
- Mgnesium sulfate
- Phenobarbital
- Sulfonamides
- Respiratory depression, CNS depression
- Respiratory depression, CNS depression
- Respiratory depression
- Vitamine K deficiency
- Displaces bilirubin from albumin
List the effects of the following drugs on the neonate
- NSAIDs
- ACE inhibitors
- Isotretinoin
- Phenytoin
- Diethylstilbestrol (DES)
- Premature closure of the ductus arteriosus
- Craniofacial abnormalities
- Facial and ear anormalies, congenital heart disease
- Hypoplastic nails, typical facies, IUGR
- Vaginal adenocarcinomas
List the effects of the following drugs on the neonate
- Tetracycline
- Lithium
- Warfarin
- Valproate/Carbamazepine
- Enamel hypoplasia, discolored teeth
- Ebstein’s anomaly
- Facial dysmorphism and chondrodysplasia
- Mental retardation, neural tube defects
- At what age does birth weight normally doubles?
- At what age does birth weight normally triples?
- At 6 months
- At 12 months (1 year)
True or False:
Height percentile at 2 years of age normally correlates with final adult height percentile
True
Best indicators for:
- Acute malnutrition
- Underweight and overweight
- Weight/height < 5 percentile
- BMI
True or False:
- Skeletal maturity is related to sexual maturity
- Psychosocial deprivation is the most common cause of failure to thrive in all age groups
- All cases of underfeeding must be reported to child protective services (CPS)
- Work up is mandatory for any child who has crossed 2 major growth percentile
- True. It is less related to chronological age
- True
- True
- True
List the advantages of breastfeeding
- Passive transfer of T-cell immunity
- Decreased risk of allergies and gastrointestinal and respiratory infections
- Psychological/emotional
- Maternal-infant bonding
List the contraindications to breastfeeding
HIV
CMV
HSV lesions on breast
HBV until infant has recieved HBV vaccine
Acute maternal disease if absent in infant (e.g., tuberculosis, sepsis)
Breast cancer
Substance abuse
Drugs
List the drugs for which there is absolute contraindications to breastfeeding
Antineoplastics
Iodine/mercurials
Lithium
Chloramphenicol
Nicotine
Alcohol
List the drugs for which there is relative contraindications to breastfeeding
Neuroleptics
Sedatives
Metronidazole
Tetracycline
Sulfonamides
Steroids
- List the newborn reflexes present at birth
- When do they disappear?
- The parachute reflex is extension of the arms when fall is stimulated. When does it appear and disappear?
- Newborn reflexes at birth:
- Moro
- Grasp
- Rooting
- Tonic neck
- Placing
- 4 to 6 months
- Appears at 6 to 8 months and persists
List the developmental milestones at:
- 9 months
- 12 months
- 15 months
- 9 months:
- Pincer grasp
- Creeps and crawls
- Knows own name
- 12 months:
- Cruises
- Says one or more words
- Plays ball
- 15 months
- Builds 3-cube tower
- Walks alone
- Makes lines and scribbles
List the developmental milestones at:
- 18 months
- 24 months
- 18 months:
- Builds 4-cube tower
- Walks down stairs
- Says 10 words
- Feeds self
- 24 months:
- Builds 7-cube tower
- Runs well
- Goes up and down stairs
- Jumps with 2 feet
- Thread shoelaces
- Handles spoon
- Says 2-3 sentences
List the developmental milestones at:
- 36 months
- 48 months
- 36 months
- Walks downstairs in alternating feet
- Rides tricycle
- Knows age and sex
- Understands taking turns
- 48 months
- Hops on one foot
- Throws ball overhead
- Tell stories
- Participate in group play
True or False:
The following are contraindications to breastfeeding
- A reaction to a previous DPT of temperature <105oF, redness, soreness, and swelling
- A mild, acute illness in an otherwise well child
- A concurrent antimicrobial therapy
- A family history of seizures or sudden infant death syndrome
- False
- False
- False
- False
True or False:
The following vaccines are contraindicated in the presence of egg allergy
- MMR
- Influenza
- Yellow fever
- False
- True
- True
- Which vaccine is given at birth?
- Which vaccine is given at 1 or 2 months?
- List the vaccines that are given at 2 months
- List the vaccines that are given at 4 months
- List the vaccines that are given at 6 months
- Hep B vaccine
- Hep B vaccine
- 2 months vaccines
- Hep B
- Rotavirus (Rota)
- Diphtheria, tetanus, pertusis (DTaP)
- Haemophilus influenzae type B (HiB)
- Pneumococcal (PCV)
- Inactivated poliovirus (IPV)
- As in (3) above except for Hep B
- As in 3 above except that Hep B and IPV may be given anytime between 6 and 18 months
- When is influenza vaccine given?
- When is MMR given routinely?
- When is Varicella vaccine given routinely?
- When is Hep A vaccine given
- Yearly from 6 months
- At 12 to 15 months and at 4 to 6 years
- At 12 to 15 months and at 4 to 6 years
- From 12 to 23 months: 2 doses
Active immunization schedule after exposure to
- Measles
- For those < 6 months
- Between 6 months to 12 months
- For those greater than 12 months
- For pregnant or immunocompromised persons
- Varicella
- For susceptible children and household contacts
- Susceptible pregnant women, newborns whose mothers had chicken pox within 5 days before delivery to 48 hours after delivery
- Measles
- 0-6 months: Ig
- 6-12 months: Ig plus vaccine
- >12 months: Vaccine only within 72 hours of exposure
- Pregnant or immunocompromized: Ig only
- Varicella
- Susceptible children and household contacts: VZIG and vaccine
- Susceptible pregnant women, newborns whose mothers had chicken pox within 5 days before delivery to 48 hours after delivery: VZIG
Active immunization schedule after exposure to
- Hepatitis B
- Hepatitis A
- Mumps and Rubella
- Ig plus vaccine; repeat vaccine at 1 month and 6 months
- For children > 2 years only: Ig plus vaccine
- No postexposure protection available
True or False:
- HiB conjugated vaccine covers nontypeable Haemophilus
- HiB conjugated vaccine is not given after 5 years
- Invasive Haemophilus influenzae infection confers immunity
- Varicella has been associated with development of herpes zoster
- Meningococcal conjugate vaccine is indicated for all college freshmen living in dormitories
- False
- True
- False. Patient still requires vaccines if < 5 years
- True
- True
Indications for hospitalization in child abuse
- Medical condition requires
- Diagnosis is unclear
- There is no alternative safe place
A 2-year-old child is brought in for a severe cough, fever, and runny nose. The cough sounds like a bark and she is in obvious respiratory distress. Upon physical examination, she refuses to lie flat. CXR shows a positive steeple sign. What is the most appropriate next step in management?
a. Intubate
b. Racemic epinephrine
c. Empiric antibiotics
d. Acetaminophen
e. CT neck
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 435). Kaplan Medical Test Prep. Kindle Edition.
B. This child presents with classic signs of croup, an inflammation that is quite literally choking off the upper airway. The seallike barking cough with URI-like symptoms gives it away. This is a medical emergency. To prevent asphyxiation and probable tracheostomy, administer racemic epinephrine to decrease swelling. Do not waste time with radiology. There is no medical evidence suggesting that intubation, antibiotics, or antipyretics decrease mortality.
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 435). Kaplan Medical Test Prep. Kindle Edition.
State (1) the diagnosis, (2) causative organism, (3) diagnostic tests, (4) outline the management including emergency measures, and (5) complications/prognosis of the following presentation:
- Age: 3 momths to 5 years
- Sore throat
- Coryza
- Hoarseness
- Deep barking cough
- Inspiratory stridor
- Tachypnea
- Symptoms are worse at night or when lying flat
- Croup
- Parainfluenza 1 or 3; Influenza A or B
- Neck X-ray (NOT needed for diagnosis)
- Mgt:
- Humified oxygen
- Nebulized epinephrine and corticpsteroids
- N/B: antitussives, decongestants, sedatives, or antibiotics are NOT used in the management of Croup
- Spontaneous resolution in 1 week; Always suspect diagnosis of epiglottitis
State (1) the diagnosis, (2) causative organism(s), (3) diagnostic tests, (4) outline the management including emergency measures, and (5) complications/prognosis of the following presentation:
- Sudden onset of muffled voice
- Drooling
- Dysphagia
- High fever
- Inspiratory stridor
- Preference for tripod position
- Refusal to lie flat
- Toxic appearance
- Epiglottitis
- H.influenzae type B (now less common); Strep pyogenes; Strep pneumoniae; Staph aureus; Mycoplasma
- Neck X-ray (thumb-print sign); Blood cultures; Nasopharyngoscopy in the OR; Epiglottic swab culture. Diagnostic workup is after stabilization as this is a medical emergency
- Mgt:
- Transfer to hospital/OR
- Consult ENT and anesthesia
- Intubate
- Give antibiotics (ceftriaxone) and steroids
- Give rifampin to all close contacts
- Airway obstruction and death
State (1) the diagnosis, (2) causative organism(s), (3) diagnostic tests, (4) outline the management including emergency measures, and (5) complications/prognosis of the following presentation:
- Age: < 3 years
- Brassy cough
- High fever
- Resp distress
- Usually preceded by a viral URTI
- NO drooling; NO dysphagia
- Bacterial tracheitis
- S. aureus
- Diagnosis based on clinical evidence and laryngoscopy
- CXR shows subglottic narrowing plus ragged tracheal air column
- Blood cultures
- Throat cultures
- Antistaphylococcal antibiotics; May require intubation if severe
- Airway obstruction
A 4-year-old child is brought in because of extreme irritability and refusal to eat. He refuses to lean back, speaks in muffled words, looks extremely ill, and is drooling. CXR shows a positive thumbprint sign.
What is the most appropriate next step in management?
a. Intubate
b. Racemic epinephrine
c. Empiric antibiotics
d. Physical examination
e. CT neck
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 436). Kaplan Medical Test Prep. Kindle Edition.
A. This child presents with classic signs of epiglottitis, the truest medical emergency in pediatrics. He must be intubated at once. Do not waste time with anything
else, including a full examination, as his airway may close off any minute. Purists even say to avoid startling the child. This case mentions a thumbprint sign to aid your studies, but CXR is rarely done with such a convincing presentation. The remaining choices are not indicated until airway management is conducted. Remember your ABCs.
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 436). Kaplan Medical Test Prep. Kindle Edition.
Epiglottitis can be differentiated from Croup by the absence of barking cough in the former
True
State the most common sites of airway obstruction in
- Children > 1 year
- Children < 1 year
- Larynx
- Trachea or right main bronchus
When is a murmur in the exam innocent?
- When there is fever, infection or anxiety
- It is systolic
- When it is < grade 2/6
True or False:
Antibiotic therapy should be started at the same time as workup for congenital heart disease (CHD)
True. This is becuse sepsis and CHD present very similarly
CHD
- Best initial tests
- Most accurate test
- List the conditions with increased vascular markings on CXR
- CXR and ECG
- Echocardiography
- Increased vascular markings
- Transposition of the great arteries (TGA)
- Hypoplastic left heart syndrome
- Truncus arteriosus
Conditions that require antibiotics prior to dental procedures
- Prosthetic valves
- Previous endocarditis
- CHD (unrepaired or repaired with persistent defect)
- Cardiac transplantation patients with cardiac valve abnormalities
True or False
Consider renal cuases of HTN in EVERY pediatric patient presenting with hypertension
True
List the screening tests for HTN in children
- CBC
- Urinalysis
- Urine culture
- Electrolytes
- Glucose
- BUN
- Creatinine
- Calcium
- Uric acid
- Lipid panel (for essential HTN and positive family hx)
List the Meckel’s Diverticulum Rule of 2s
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 426). Kaplan Medical Test Prep. Kindle Edition.
- Affects 2% of population
- Occurs 2 feet from the ileocecal valve
- Affects 2 types of ectopic tissue (gastric and pancreatic)
- Male patients 2 times more affected
- Patient < age 2
- Only 2% of patients symptomatic
- About 2 inches long
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 426). Kaplan Medical Test Prep. Kindle Edition.
List the Meckel’s Diverticulum Rule of 2s
- Affects 2% of population
- Occurs 2 feet from the ileocecal valve
- Affects 2 types of ectopic tissue (gastric and pancreatic)
- Male patients 2 times more affected
- Patient < age 2
- Only 2% of patients symptomatic
- About 2 inches long
Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 426). Kaplan Medical Test Prep. Kindle Edition.
Indications for hydroxyureas in sickle cell anemia
- => 3 crises per year
- Symptomatic anemia
- Life-threatening complications
List the routine care for sickle cell anemia patients
-
Penicillin prophylaxis
- Begins at 2 months until 5 years of age
-
Immunizations
- Regular immunizations
- Pneumococcal at 2 months
- Influenza vaccine at 6 months then yearly
- Meningococcal at 2 years
- Daily folate supplementation
What is the age of the child with the following developmental milestones?
- Walks downstairs in alternating feet
- Rides tricycle
- Knows age and sex
- Understands taking turns
36 months (3 years)
What is the age of the child with the following developmental milestones?
- Hops on one foot
- Throws ball overhead
- Tell stories
- Participate in group play
48 months (4 years)
What is the age of the child with the following developmental milestones?
- Pincer grasp
- Creeps and crawls
- Knows own name
9 months
What is the age of the child with the following developmental milestones?
- Cruises
- Says one or more words
- Plays ball
12 months
What is the age of the child with the following developmental milestones?
- Builds 3-cube tower
- Walks alone
- Makes lines and scribbles
15 months
What is the age of the child with the following developmental milestones?
- Builds 4-cube tower
- Walks down stairs
- Says 10 words
- Feeds self
18 months
What is the age of the child with the following developmental milestones?
- Builds 7-cube tower
- Runs well
- Goes up and down stairs
- Jumps with 2 feet
- Thread shoelaces
- Handles spoon
- Says 2-3 sentences
24 months
Management for lead poisoning
- Blood lead level <= 10ug/dL
- Blood lead level between 10 and 14 ug/dL
- Blood lead level > 15 ug/dL
- Blood lead level bwtween 15 and 19 ug/dL
- Blood lead level bwtween 20 and 44 ug/dL
- Blood lead level bwtween 45 and 70 ug/dL
- Blood lead level > 70ug/dL
- Acceptable level
- Repeat blood test in 3 months
- Evaluation of the source, education, and a health department referral
- Repeat blood test in 2 months
- Repeat blood test in 1 week
- Chelation therapy with one oral drug, succimer and repeat blood test in 1 month
- Hospitalize patient, and treat with 2 chelation drugs, dimercaprol (BAL) and calcium EDTA
