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Pediatrics > VLC Peds 2: Young Child (up to 4y) > Flashcards

VLC Peds 2: Young Child (up to 4y) Flashcards

1
Q

When examining an infant, what components do you perform first and why?

A

Ausculatation of heart and lungs: in case infant starts to cry (wouldn’t be able to auscultate well then)

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2
Q

What is the DDx for diagnosis of limp / refusal to walk in a child?

A

Leukemia

Reactive arthritis
Septic arthritis
Juvenile idiopathic arthritis

Transient synovitis

Slipped capital femoral epiphysis (SCFE)
Trauma
Osteomyelitis

Legg-Calve-Perthes disease

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3
Q

What must always be considered on the DDx for a child refusing to walk?

A

Leukemia

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4
Q

How might leukemia present, before systemic signs like fever and weight loss?

A

Bone pain

Can present as limp or refusal to walk, or localized discomfort of jaw, long bones, vertebrae, hip, scapula, or ribs.

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5
Q

What causes bone pain in leukemia?

A

Replacement of bone marrow by leukemic cells

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6
Q

What is osteomyelitis?

A

Infection of the bone

Usually bacterial, most often Staph aureus (and before immunization, Haemophilus influenzae)

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7
Q

What proportion of osteomyelitis cases involve a history of fever?

A

About half

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8
Q

How does leg or hip osteomyelitis present in toddlers ?

A

Pain and refusal to bear weight

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9
Q

Is the presentation of osteomyelitis rapid or indolent?

A

Indolent: can take 5-10 to diagnose

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10
Q

Reactive arthritis is most common in which age group?

A

Adolescents and young adults

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11
Q

True or false: children with reactive arthritis usually have fever

A

False: usually afebrile

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12
Q

What typically precedes reactive arthritis?

A

Infection outside the joint, eg GI or GU, usually 2-4 weeks previously

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13
Q

What is classically associated with reactive arthritis?

A

Urethritis and conjunctivitis

Note: this presentation is uncommon in children

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14
Q

What is septic arthritis?

A

Bacterial infection of a single joint, usually in a lower extremity

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15
Q

Septic arthritis is most common in which age group?

A

0-6 years old

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16
Q

What non-joint symptoms present with septic arthritis?

A 
High fever 
Constitutional Sx (decreased appetite, irritability, malaise)
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17
Q

What is transient synovitis?

A

Transient inflammation of a joint. Relatively common.

Etiology not clear; some suspect post-infectious

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18
Q

What non-joint symptoms present with transient synovitis?

A

Few: there may be a low-grade fever, but no significant constitutional Sx otherwise.

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19
Q

What is the time course of transient synovitis?

A

Acute onset (eg one day)

Pain usually completely resolves within 3-10 days

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20
Q

What is juvenile idiopathic arthritis?

A

Group of disorders characterized by chronic inflammation of joints

Criteria:

  • children must be less than 16 years of age
  • must have arthritis in at least one joint for more than six weeks
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21
Q

What are the subtypes of juvenile idiopathic arthritis?

A 
Systemic
Oligoarthritis
Polyarthritis
Psoriatic arthritis
Enthesitis-related arthritis
Other
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22
Q

What features does systemic JIA have?

A

Systemic: constitutional Sx and rash

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23
Q

What features does oligoarthritic JIA have?

A

Onset is acute
Usually affects the knee
Associated with asymptomatic iridocyclitis (infl of iris and ciliary muscles)

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24
Q

What is the most common hip disorder in adolescents?

A

Slipped capital femoral epiphysis

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25
Q

What is slipped capital femoral epiphysis?

A

Posterior displacement of capital femoral epiphysis relative to the femoral neck at the cartilage growth plate

(actually is anterior/anterolateral displacement of femoral neck–head & epiphysis are well held in acetabulum)

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26
Q

What are the symptoms of slipped capital femoral epiphysis?

A

Limp and impaired internal rotation

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27
Q

How is slipped capital femoral epiphysis managed?

A

Depends on degree of slip, & complications (AVN of femoral head, destruction of articular cartilage)

Usually involves pinning to stabilize epiphysis

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28
Q

What is Legg-Calve-Perthes disease?

A

Indolent condition of unclear etiology

Involves avascular necrosis of capital femoral epiphysis

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29
Q

What is the management and prognosis of Legg-Calve-Perthes disease?

A

Prognosis: usually self-resolving, may lead to complications like femoral head deformity & degenerative arthritis

Treatment usually involves referral to Ortho, but is usually conservative

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30
Q

In which demographic group is Legg-Calve-Perthes disease most common?

A

Boys 4-10 years old

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31
Q

In which areas are bruises not suspicious in young active children? In which area are bruises suspicious?

A

Not suspicious: Bony prominences (eg shins, forearms)

Suspicious: well-cushioned areas (e.g. buttocks, back)

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32
Q

True or false: bruises cannot be reliably aged based on colour

A

TRUE

Don’t ever say “bruises in various stages of healing” – you don’t know! Can describe colour instead

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33
Q

What does the Ortolani maneuver test?

A

Dislocated hip, specifically whether you can reduce an existing dislocated hip

Move: Ortolani Opens

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34
Q

What does the Barlow maneuver test?

A

Dislocated hip, specifically whether it is very easy to posteriorly dislocate a hip

Move: Barlow pushes Back

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35
Q

What is the spectrum of developmental hip dysplasia?

A 
hips that are 
dysplastic
dislocatable
subluxated (partially dislocated)
dislocated
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36
Q

Name 3 risk factors for developmental hip dysplasia

A

Female sex
Breech delivery
Family history of DDH

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37
Q

What are the two most common manifestations of Lyme disease?

A

Rash
Arthritis

Arthritis is the most common manifestation of late Lyme disease

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38
Q

How is Lyme arthritis diagnosed?

A

Clinically, based on rash and other symptoms

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39
Q

What other symptoms are associated with Lyme arthritis?

A 
Characteristic rash (erythema migrans)
Fever
Malaise
Fatigue
Headache
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40
Q

What joints are most commonly affected by Lyme arthritis?

A

Large joints closest to the rash

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41
Q

True or false: Lyme arthritis occurs only once

A

False: it can occur only once, but it may also relapse

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42
Q

What symptoms and investigations are used to predict septic arthritis of the hip (for further Ix and definite Dx)?

A 
Non-weight-bearing
Fever
Elevated WBC
Elevated ESR
Elevated CRP
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43
Q

How is septic arthritis diagnosed?

A

Joint aspiration
Should be performed by ortho

Aspirate then sent for culture

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44
Q

What are the most common causative organisms of septic arthritis?

A

Staphylococcus aureus

Streptococcus (neonate: group B; infant and older child: Group A and Streptococcus pneumoniae)

Haemophilus influenzae type b (in unimmunized children)

Neisseria gonorrhea (adolescents)

Kingella kingae (in children less than 4 years)

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45
Q

What is the management of septic arthritis?

A
  • Abx (empiric first, targeted after culture)
  • May require I&D

May require prolonged Abx and repeat aspiration / I&D

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46
Q

What is the treatment of transient synovitis?

A

Rest and ibuprofen

47
Q

What is the prognosis of transient synovitis?

A

Good: small chance of recurrence, but no long-term effects.

Does not predispose individuals to arthritis.

48
Q

What is important to ask about on history for a child with a limp?

A
  • Bruising
  • Any previous similar episodes
  • Recent sickness
  • Other Sx (eg constitutional)
  • Sick contacts / exposures
49
Q

What labs are most useful to order in initial evaluation of painful hip?

A

WBC (CBC)
CRP
ESR

50
Q

What is the AEIOU-TIPS mnemonic for altered mental status?

A

AEIOU-TIPS

Alcohol, ingested toxins
Epilepsy, encephalitis, endocrine, electrolytes
Infection (meningitis/sepsis)
Overdose, opiates, oxygen deprived
Uremia (renal failure)
Trauma, temperature
Insulin
Psychosis
Stroke, shock, space occupying lesions
51
Q

Give a DDx for a 2yo with altered mental status

A

Infection (sepsis, meningitis, encephalitis)
toxic ingestion
trauma
seizure

52
Q

What are the first five steps in management of a child presenting with acute altered mental status?

A

ABC
Vitals
Glucose

53
Q

What history should be gathered urgently when a young child presents with AMS?

A

Fever
Events
Possible toxic exposures

54
Q

How do you initially stabilize a child with hypoglycemia?

A

A bolus of 10% or 25% solution of dextrose (D10 or D25)

55
Q

How do you initially stabilize a child with tachycardia and hypotension?

A

A bolus of 20 cc/kg normal saline

56
Q

What are the 5 main toxidromes?

A 
Cholinergic
Anticholinergic
Sedative-hypnotic
Opioid
Sympathomimetic
57
Q

Name 5 features of the cholinergic toxidrome (7 listed)

A

Miosis and blurred vision

Increased gastric motility (nausea, vomiting, diarrhea)

Excessive tearing, salivation, sweating and urination

Bronchorrhea and bronchospasm

Muscle twitching and weakness

Bradycardia

Seizures and coma

58
Q

Name 5 features of the anticholinergic toxidrome (9 listed)

A

Mydriasis (dilated pupils)

Dry skin

Red skin (flushed)

Fever

Delirium and seizures

Tachycardia

Urinary retention

Ileus

Blind as a bat, dry as a bone, hot as a hare, red as a beet, mad as a hatter

59
Q

Name 5 features of the sedative-hypnotic toxidrome (5 listed)

A

Blurred vision (miosis or mydriasis)

Hypotension

Apnea and bradycardia

Hypothermia

Sedation, confusion, delirium, coma

60
Q

Name 5 features of the opioid toxidrome (5 listed)

A

Miosis (constricted pupils)

Respiratory depression

Bradycardia and hypotension

Hypothermia

Depressed mental status (sedation, confusion, coma)

61
Q

Name 4 features of the opioid toxidrome (4 listed)

A

Mydriasis

Fever and diaphoresis

Tachycardia

Agitation and seizures

62
Q

Diphenhydramine & tricyclic antidepressants cause which toxidrome?

A

Anticholinergic

63
Q

Cocaine, amphetamines, and pseudoephedrine cause which toxidrome?

A

Sympathomimetic

64
Q

Neostigmine, ipratropium, rivastigmine, donepizil cause what toxidrome?

A

Cholinergic

65
Q

Organophosphate insecticides cause which toxidrome?

A

Cholinergic

66
Q

What labs should be ordered for a child with suspected toxic ingestion?

A 
Glucose
Lytes and/or blood gas
EKG
Tox screen
Acetaminophen
67
Q

Why do acetaminophen on top of the standard tox screen?

A
  • not included on standard
  • most common accidental ingestion
  • common co-ingestion
  • management is guided by plasma concentration, so separate serum level is recommended
68
Q

What clinical characteristics would contraindicate use of activated charcoal?

A

Loss of ability to protect airway (due to risk of aspiration)

69
Q

Until what age should corrected gestational age be used?

A

2 years

70
Q

How is corrected gestational age calculated?

A

40 - weeks at birth
Subtract that from current age

Eg 18mo born at 29w:
40-29 = 11
18mo - 11w = ~15.5 mo

71
Q

What is the age range between which 95% of typically developing children start to walk?

A

9-17 months!

72
Q

By what age does a child’s gait have the approximate appearance of an adult’s (eg heel strike)?

A

3 years

73
Q

What are the five main domains of development?

A 
Gross motor
Fine motor
Communication (expressive and receptive)
Personal-Social
Problem solving (aka cognitive, adaptive, self-help)
74
Q

A toddler prefers standing to sitting. What concern should lead you to characterize this more fully?

A

May do so because of abnormally tight muscles, possibly due to a neuromuscular disorder.

75
Q

What information does, “Does your toddler have a favourite toy?” elicit?

A

Demonstration of an intense interest in one “toy” or object to the exclusion of others is atypical at this age and may be symptom of an underlying developmental disorder.

76
Q

When does handedness develop?

A

18-24mo; appearance of hand preference before this might indicate contralateral weakness, and should be investigated

77
Q

What simple rule of thumb guides assessment of expressive language?

A

sentence length equals age in years

1yo: several single words
2yo: simple, two-word sentences
3yo: uncountable number of words in sentences three words long or longer

78
Q

Why ask if a toddler gets along with family members?

A

Difficulty or lack of interest are both concerning & require further evaluation

79
Q

When do children start imitating adult activities (cleaning, cooking)?

A

around 18mo

Lack of interest is atypical

80
Q

What is one question you can you ask to assess regression?

A

“Are there any skills that it seems like your child had developed and then lost?”

81
Q

What is the most variable component of development?

A

Language

Tell parents this!

82
Q

Which is a better indicator of long-term language outcomes?

A

Receptive language (though most of our tools assess expressive)

83
Q

What is the prevalence of autism spectrum disorder?

A

1 in 68 (1.5%)

84
Q

What is autism spectrum disorder?

A

developmental disorder characterized by

  • differences in social communication and interaction
  • restricted or repetitive behaviours, interests, or activities.
85
Q

When should screening take place for autism spectrum disorder?

A

18mo and 24mo

86
Q

Name 4 conditions that are more common among premature infants that are risk factors for developmental delay

A

Bronchopulmonary dysplasia
Retinopathy of prematurity
Hyperbilirubinemia
Periventricular leukomalacia

87
Q

If you see two dots connected by a horizontal line on a growth curve, what does that likely mean?

A

Plotting both chronological and corrected age

88
Q

By what age should the Babinski reflex disappear?

A

Around when the child starts walking, but definitely by 2y

89
Q

What are some signs of hypotonia in an infant or toddler?

A

Slumped posture, poor head control, pt slipping through hands when held under armpits

90
Q

What is a circle, on a pedigree?

A

Female

91
Q

What is a square, on a pedigree?

A

Male

92
Q

What is a triangle, on a pedigree?

A

Spontaneous abortion (with a line through it indicates termination of pregnancy)

93
Q

What does a line through a square, circle, or triangle mean, on a pedigree?

A

Death

Square or circle with SB underneath: stillbirth
Triangle: termination of pregnancy

94
Q

What is the likeliest diagnosis for an ex-29-week preemie with delayed developmental milestones and hypertonia and spasticity on exam?

A

CP

95
Q

What is spasticity?

A

Velocity-dependent increased muscle resistance

96
Q

What is a sign of increased calf tone? What would you assess?

A

Toe-walking

Assess dorsiflexion

97
Q

What hand posture is a sign of CNS dysfunction (when held persistently beyond the first few months of life)?

A

Persistently closed hands

Thumb held in palm

98
Q

What are the types of CP?

A 
Spastic quadriplegia
Spastic diplegia
Spastic hemiplegia
Dyskinetic
Ataxic
99
Q

What is the general pattern, classic etiology, and clinical scenario for the CP subtype spastic quadriplegia?

A

General pattern: Entire body
Classic etiology: Global brain abnormalities
Common clinical scenario: Various

100
Q

What is the general pattern, classic etiology, and clinical scenario for spastic diplegia (CP subtype)?

A

General pattern: Legs more affected than arms
Classic etiology: Periventricular WM abnormality
Common clinical scenario: Premature infants

101
Q

What is the general pattern, classic etiology, and clinical scenario for dyskinetic CP?

A

General pattern: Variable, often entire body
Classic etiology: Basal ganglia, cerebellum, and/or thalamus
Common clinical scenario: perinatal asphyxia, kernicterus

102
Q

What is the general pattern, classic etiology, and clinical scenario for spastic hemiplegia (CP subtype)?

A

General pattern: Unilateral arm & leg
Classic etiology: Unilateral UMN abnormality
Common clinical scenario: Stroke

103
Q

What is the general pattern, classic etiology, and clinical scenario for ataxic CP?

A

General pattern: Entire body
Classic etiology: Cerebellar abnormalities
Common clinical scenario: Cerebellar hypoplasia, pontocerebellar hypoplasia

104
Q

What is cerebral palsy?

A

Heterogenous group of nonprogressive disorders

Characterized by motor and postural dysfunction

105
Q

True or false: children raised bilingual have slower language development than children raised monolingual

A

Mixed: Bilingual children may start somewhat later, but first words should still appear within the normal age range

106
Q

How many words should bilingual children be able to speak by 20mo?

A

20 words from both languages combined

107
Q

By what age do bilingual children use their languages separately?

A

4y

108
Q

What is the biggest single risk factor for CP?

A

Prematurity

78% of children with CP were premature

109
Q

What is the general initial workup for CP?

A

Detailed H&P
Screening
Neuroimaging
Developmental testing

110
Q

Why is a detailed history & physical important in the initial evaluation of CP?

A

1) determine that the condition is static (not degenerative or progressive), and 2) classify the type of CP

111
Q

What kinds of screening should be done in children with CP?

A 
Developmental
Ophthalmologic
Hearing
Speech and language
Oral-motor function
112
Q

What additional testing might you consider in working up suspected CP, and why?

A

If features of epilepsy: EEG

If
- features suspicious for metabolic or genetic disorder, or
- no structural abnormalities on imaging
Metabolic and genetic testing

113
Q

When should a child with intellectual disability get chromosomal testing?

A

Most experts recommend chromosomal testing in all children with intellectual disability. (American site, but still)

Pediatrics (8 decks)

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