Well Child/ Pediatrics Flashcards
When can a child start to use a front facing car seat?
- 1 year old and weighing at least 20lbs
What measurements should be taken at every well child visit?
- Height, weight, and head circumference should be measured and plotted on a growth chart.
At what age should children have their blood pressure checked?
Children >3yo can have their blood pressure checked
What is considered “failure to thrive”?
Failure to thrive is defined as weight below the third or fifth percentile for age OR decelerations of growth decelerations of growth that have crossed two major growth percentile in a short period of time.
What screening tests are required of all newborns in all states?
- PKU
- Congenital hypothyroidism
- Hearing screening by auditory brainstem response or evoked otoacoustic emission
- Hemoglobinopathies, galactosemia, and other inborn errors in metabolism are also often screened
When should universal screening of lead poisoning be done according to the CDC?
- 9-12months and again at 2 years in communities where >27% of homes were built before 1950s (or >12% have a venous lead concentration more than 10micrograms/dL)
What are the motor, language, and social milestones of a 1 month old?
Motor: reaction to pain
Language: responds to noise
Social: regards human face; establishes eye contact
What are the motor, language, and social milestones of a 2 month old?
Motor: eyes follow object to midline; head up prone
Language: vocalizes
Social: social smile; recognizes parent
What are the motor, language, and social milestones of a 4 month old?
Motor: eyes follow object past midline; rolls over
Language: laughs and squeals
Social: regards hand
What are the motor, language, and social milestones of a 6 month old?
Motor: sits well unsupported; transfers objects hand to hand; rolls prone to supine
Language: babbles
Social: recognizes strangers
What are the motor, language, and social milestones of a 9 month old?
Motor: pincer grasp (10months); crawls; cruises
Language: mama/dada, bye bye
Social: starts to explore
What are the motor, language, and social milestones of a 1 year old?
Motor: walks; throws objects
Language: 1-3 words; 1 step commands
Social: stranger and separation anxiety
What are the motor, language, and social milestones of a 2 year old?
Motor: walks up and down stairs; copies a line; runs; kicks a ball
Language: 2-3 word phrases; strangers can understand half; refers to self by name and pronouns
Social: parallel play
What are the motor, language, and social milestones of a 3 year old?
Motor: Copies a circle; tricycle; can build a bridge of 3 cubes; repeats 3 numbers
Language:speaks in sentences, 3/4 of speech is understood by strangers; recognizes 3 colors
Social: group play, simple games, knows gender, and first and last name
What are the motor, language, and social milestones of a 4 year old?
Motor: identifies body parts; copies a cross/square; hops on one foot, throws overhand
Language: speech is fully comprehensible, uses past tense, can tell a story
Social: plays with kids, social interaction
What are the motor, language, and social milestones of a 5 year old?
Motor: copies a triangle, catches a ball, partially dresses self
Language: writes name, counts 10 objects
What are the motor, language, and social milestones of a 6 year old?
Motor: draws a person with 6 parts, ties shoes, skips with alternating feet
Language: identifies left and right
What is the most common cause of anemia in children?
Iron deficiency anemia
What is the cover uncover test?
- Child focuses on an object with both eyes and the examiner covers one eye
- Strabismus is suggested when the uncovered eye deviates to focus on the object
- Strabismus requires an immediate referral to a pediatric ophthalmologist as early intervention can reduce amblyopia
At what age can a child be put in a booster type seat with shoulder/lap seat belts?
- > 1yo and 20-40lbs
When can children sit without a booster seat?
When they are 4’9”
What sleeping position reduces sudden infant death syndrome?
Placing the child to sleep on its back reduces incidence of sudden infant death syndrome.
* A firm mattress with nothing else in the crib is also advised
What vaccinations should be given at birth?
- Hep B
When are the Hep B vaccinations given?
1) At birth
2) 1-2 months
3) 6-18months
Given a total of 3 times
What vaccinations are given at 2 months?
- Hep B (1-2 months)
- Rotavirus
- Dtap
- Hib
- Pneumococcal
- Inactivated polio
What vaccinations are given at 4 months?
APART FROM Hep B, SAME AS 2 MONTHS:
- Rotavirus
- Dtap
- Hib
- Pneumococcal
- Inactivated polio
What vaccinations are given at 6 months?
- Hep B (any time 6 months- 18 months)
- Rotavirus
- Dtap
- Hib
- Pneumococcal
- Inactivated polio (anytime form 6 months-18 months)
- Flu (yearly)
At what age can children begin to receive the annual flu vaccine?
- 6 months
What vaccinations are given at 12 months?
- Hep B (any time 6 months- 18 months)
- Hib (last/4th dose from 12-15 months)
- Pneumococcal (last/4th dose, anytime from 12-15 months)
- Inactivated polio (4th dose, anytime from 6-18 months)
- Yearly flu
- MMR ( anytime 12-18 months)
- Varicella ( anytime 12-18 months)
- Hep A 2 doses ( anytime 1-2 years)
When should the DTaP vaccine be given?
1) 2 months
2) 4 months
3) 6 months
4) 15-18 months
5) 4-6 years
6) 11-12 years (Tdap)
When should the polio vaccine be given?
1) 2 months
2) 4 months
3) 6 -18 months
4) 4-6 years
When is the MMR vaccine given?
1) 12-18 months
2) 4-6 years
When is the varicella vaccine given?
1) 12-18 months
2) 4-6 years
When should the meningococcal vaccine be given?
11-12 years
When should the HPV vaccine be given?
11-12 years (3 doses)
What inherited forms of anemia can be seen in children?
- sickle cell disease
- thalassemias
- G6PD deficiency
When can cervical cancer screening (i.e. pap smears) be initiated?
- Age 21 and every 3 years until age 30; then can be every 5 years with HPV testing
What is the most common cause of sudden cardiac death in young athletes?
- Hypertrophic cardiomyopathy
What genetic condition is associated with aortic root dilation/dissection?
- Marfan syndrome
What is the hallmark physical exam finding in hypertrophic cardiomyopathy?
- systolic murmur that decreases in intensity with the athlete in the supine position (increased ventricular filling, decreased obstruction)
- increases with the valsalva maneuver (decreased ventricular filling, increased obstruction)
- should be noted that most murmurs decrease with Valsalva, so an increase in intensity would be suspicious/worrisome
What are the criteria for cardiology referral in suspected HCM?
- systolic murmur intensity of 3/6
- diastolic, holosystolic or continuous murmur
The HPV vaccine protects against which strains?
- 6, 11, 16, 18
When should the meaningoccal vaccination be given?
- Ages 11-12 years
A 12 month old infant has sudden onset intermittent crying with vomiting that later became bilious. As the day progressed, his bouts of pain became more severe, each lasting about 20 minutes. On exam, the infant does not yet reveal signs of hypovolemia, sepsis or shock. On palpation of the abdomen, there dis generalized tenderness and a sausage like mass on the right side. Even though not mentioned by the parent, there is a small amount of bloody-mucous still that is best described as “currant jelly.” What is the most likely diagnosis?
- Intussception that has progressed to an obstruction
- presents risk for perforation with ensuing shock and sepsis
What is the next diagnostic step in the case of intussception?
- abdominal plain x rays to rule out perforation
Bilious vomiting is suggestive of what condition?
- intestinal obstruction
What other condition may present similarly to intussception?
- volvulus
Where would a palpable mass be felt in the case of pyloric stenosis?
- olive shaped mass in the right upper quadrant of the epigastrium due to gastric outlet obstruction
- occurs in children in about 1 month of age ( male predominance)
What is currant jelly stool?
- Mixture of blood and mucous
What procedure is both diagnostic and therapeutic in the case of intussception?
- Barium enema
What is the next step if perforation is found in the context of intussception?
- surgery
What should be on the differential diagnosis in the case of a pediatric abdominal emergency?
- hypertrophic pyloric stenosis
- malrotation with volvulus/obstruction
- foreign body ingestion
- poisoning
- intussception
What is the definitive treatment of hypertrophic pyloric stenosis?
- surgery
What is the test and treatment of choice in malrotation?
- upper GI series
- Tx: surgery
If a child who is suspected to be poisoned presents with salivation, lacrimation, diarrhea, vomitting, diaphoresis, intestinal cramps, and seizures, what syndrome is suspected?
- cholinergic syndrome
If a child who is suspected to be poisoned presents with dry skin, dry mucosa, urinary retention, and decreased bowel sounds what syndrome is suspected?
- anticholinergic syndrom
* think antihistamines and TCAs
What is antalgic gait?
- Antalgic gait occurs when the stance phase of the gait is shortened, usually because of pain during weight bearing
What are the symptoms of slipped capital femoral epiphysis?
- absence of specific injury
- pain in the groin, thigh, or knee
- often in overweight male adolescents
- pain with internal rotation of the hip
- external rotation on passive flexion of the affected hip
Stiff walking, to avoid movement of the spine would indicate??
- Discitis
Clawing of the toes or caves deformity is a sign of?
- Neuromuscular condition
If an infectious cause is thought to be the cause of joint abnormalities, what test should be done?
- CBC
Septic arthritis should be worked up with what diagnostic step?
- joint aspiration and evaluation of synovial fluid
How might a septic joint present?
- Fever greater than 99.5F
- ESR >20
- Elevated CRP
- Test sexually active teens for gonorrhea
How might children with a septic hip joint move?
- Children with a septic hip joint will often lay with their hip flexed, abducted and externally rotated
What are the most common organisms involved in septic joints of children 4 months or younger?
- GBS
- Staph. aureus
What are the most common organisms involved in septic joints of children 5y ears or younger?
- S. aureus
- Streptococcus pyogenes
- treat with surgical debridement and abx
What joint pain is common after viral infection?
- Transient synovitis: self-limited inflammatory response that is common case of hip pain in children (ages 3-10; boys>girls)
- pain with internal rotation, otherwise normal labs and imaging
What is Legg-Calve- Perthes disease?
- Avascular necrosis of the femoral head
- Mostly ages 4-8yo
- More boys than girls
- Caused by disruption of blood flow to the femoral capital epiphysis due to unknown cause
- X-rays may rev lea collapse, flattening, and widening of the femoral head
What is a slipped capital femoral epiphysis?
- Separation of the femoral growth plate, which results in the femoral head being medially and posteriorly displaced
What do early and late images of slipped capital femoral epiphysis show?
- Early: widening of the epiphysis
- Later: slippage of the femoral head in relation to the femoral neck
What is the treatment for slipped capital femoral epiphysis?
- surgical pinning of the femoral head
* must follow closely as 33% develop avascular necrosis and 33% develop SCFE in the contralateral hip
What type of pain would be a red flag for malignancy in a child?
- Pain that awakens from sleep
What is the most common cause of acute wheezing in children younger than 2yo?
Bronchiolitis
What virus accounts for 70% of bronchiolitis in children less than 2yo?
Respiratory syncytial virus (RSV)
What are risk factors for cases of severe RSV infection?
- cardiac or pulmonary disease
- premature birth
- very young age
- nosocomial infection
Which type of RSV patients need to be hospitalized?
- respiratory distress
- younger than 3 months or premature
- comorbid conditions
- lethargy
- hypoxemia
- hypercarbia
- atelectasis
- consolidation
What is the inpatient treatment of RSV?
- Supplemental oxygen
- supportive care
Who should receive the RSV immunoglobulin?
- Children younger than 2yo who were born prematurely or who suffer from chronic lung disease, just before RSV season
What is the most common cause of airway obstruction in children from 6mo-6years?
Croup
What areas are affected by croup?
- Croup is a viral infection that causes inflammation of the subglottic region of the larynx that produces the characteristic barking cough, hoarseness, stridor, and respiratory distress (especially at night)
What organisms generally cause croup?
- Croup occurs in the fall and winter and is cause by: parainfluenza, adenovirus, RSV, rhinovirus, enterovirus, influenza viruses, and rarely mycoplasma pneumoniae
What is the steeple sign?
- Steeple sign is seen on frontal neck x ray and indicates subglottic narrowing of the tracheal lumen
What is the presentation of severe croup?
- cyanosis
- decreased levels of consciousness
- progressive/severe stridor
- severe retractions
- markedly decreased air movement
- toxic appearance
- severe dehydration
How is epiglottitis caused?
- Epiglottitis is a bacterial infection of the supraglottic tissue and surrounding areas that cause rapidly progressive airway obstruction
- Usually affects children less than 5yo
- Most commonly caused by: Haemophilus influenza, H. parainfluenzae, streptococcus pneumonia, staphylococcus aureus, beta hemolytic strep (A,B, C)
What are the symptoms of epiglottitis?
- toxic appearance
- developing fever
- severe sore throat
- muffled speech
- drooling
- dysphagia
- wheezing
- stridor
- child may be sitting and leaning forward with chin thrusted forward and neck hyperextended to increase airway diameter
What is the classic radiographic finding for epiglottitis?
Thumb sign => protrusion of the enlarged epiglottis from the anterior wall of the hypo pharynx seen on a lateral neck X-ray
What ABX should be used for epiglottitis?
- oxacillin. nafcillin
- cephalosporin
- clindamycin
Why is epiglottis a medical emergency?
- Can lead to airway obstruction
- death by: hypoxia, hypercapnia, and acidosis that leads to cardiorespiratory failure
What age group is most affected by retropharyngeal abscess?
- Children 2-4 years old
* usually caused by extension of pharyngeal infection, penetration trauma, iatrogenic instrumentation, or foreign body
What are the symptoms of retropharyngeal abscess?
- fever
- drooling
- dysphagia
- odynophagia
- stridor
- respiratory distress
- enlarged cervical adenopathy
How is diagnosis of retropharyngeal abscess made?
- Lateral neck x ray: bulging in the posterior pharynx
What is the treatment for retropharyngeal abscess?
- Cephalosporins
- Antistaphylococcal penicillins
- incision and drainage
What age group is most affected by peritonsillar abscess?
Young teenagers: infection of the superior pole of the tonsil
What are the symptoms of peritonsillar abscess?
- fever
- sore throat
- muffled voice
- drooling
- trismus
- neck pain
- enlarged tonsils
- cervical adenopathy
- deviation of the uvula
What are the predominant pathogens in peritonsillar abscess?
- Strep pyogenes
- S. aureus
- anaerobes
What antibiotics should be used to treat peritonsillar abscess?
- Ampicilin-sulbactam
- clindamycin
- drainage of the abscess
An 18month girl is brought in for evaluation of a rapidly spreading rash from the trunk to the extremities (sparing the face) that started after 3 days of fever. She has diffuse, blanching, erythematous macules, and papules but otherwise appears well. What is the most likely diagnosis?
- Roseola Infantum (Human herpes virus 6)
* also called 6th disease
What is the treatment for roseola?
- Supportive only as the rash often dissolve sin 24-48 hours
