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Pediatrics

Stack #137668

Objective Question	Objective Answer
**What is the CP of Asthma	Chest pain, cough, wheeze, dyspnea, tachypnea; Suspect in any child w/ wheezing on more than 1 occasion, ,on examination, if a baby, may result in Harrison's sulci, eczema evidence
What is the diagnostic evaluation should be done for a child coming in w/ wheezing	Chest x-ray to r.o. obstruction
What other things should be done to evaluate for Asthma	HPPPA - Hx, Peak Expiratory flow, PFT, Pulse Oximetery, and ABG's
What PE should be done for a pt. complaining of wheezing?	Lung exam to hear the wheezing on Auscultation
What does wheezing sound like?	Whistling heard from the chest
What ??'s should be asked to determine the pattern of the asthma?	How frequent are the sx's, how much missed school? is exercise, activity affected? if so, how? is sleep disturbed by asthma? How severe are the interval sx's bet. exacerbations
What Rx should be used for mild intermittent Asthma?	Albuterol prn
What Rx should be given to a pt. w/ mild persistent asthma?	Leukotriene Inhibitor, Inhaled Steroids (most effective), or Cromolyn
What Rx would you usefor a Moderate Persistent Asthma?	Inhaled steroid AND either an inhaled Leukotriene inhibitor or Salmeterol, or Cromolyn
**What Rx should be used in Severe Persistent Asthma?	Inhaled steroid AND Cromolyn AND possibly salmeterol and possibly theophyline and possibly oral steroids
***What is Croup?	Laryngotracheobronchitis
Who is most affected with Croup?	older infants and toddlers
What is the peak age of Croup?	2 y.o.
What season is Croup mostly found in?	Fall
What is the etiology of Croup?	Parainfluenza virus is MC
What is the CP of Croup?	Prodromal URI, LOW grade fever, Seal-like cough, increased secretions w/ edema @ subglottic area
What is used for diagnostic evaluation of Croup?	Hx, exam and AP x-ray of neck
What will you see on X-ray for Croup?	Steeple sign (inverted V) due to the subglottic tracheal narrowing
Is croup an emergency?	No
How is mild croup treated?	Managed at home
**How is moderate Croup managed?	Cool mist tent, hydration, minimal disturbance, Dexamethasone .3-.6 mg/ kg x 1 dose, Racemic epinephrine every 1-2 hrs., observe for min of 2-4 hrs
When should a pt. w/ croup be hospitalized?	In severe illness - If more than 1 TX needed
What is the CP of pharyngitis?	Sore throat
What is the CP of Tonsillitis	Intense inflammation of the tonsils, often w/ purulent exudate if bacterial, have more constitutional sx's
What is the MC etiology of Pharyngitis	Adenovirus
How does Adenovirus present?	Pink eye, sore throat, pharynoconjunctival fever
What is the most common Bacterial cause of Pharyngitis?	Group A beta Hemolytic Strep
Is pharyngitis common in children under 3?	No
How is Strep caused pharyngitis Dx'd?	Culture is gold std.
What are the complications of pharyngitis?	Upper airway obstruction, peritonsillar abscess, acute rheumatic fever, and Post Strep Glomerulonephritis
**What is the TX for bacterial Pharyngitis?	Abx - erythromycin, penicillin for 10 days
Why do we TX Pharyngitis?	B/c of rheumatic fever
**What is the CP of Epiglotitis?	HIGH fever, Toxic appearance, muffled voice, dyspnea, unable to swallow so drooling, TRIPOD Stance
**What is the Et. of Epiglottis?	H. influenzae type B
Is epiglottitis an emergency?	YES
**What is the diagnostic evaluation for epiglottitis?	Lateral X-ray of the neck - thumb sign
How is epiglottitis TX?	Controlled intubation w/ anesthesia on Emergency basis, Abx: cefuroxime
Onset of Croup vs. Epiglottitis	Croup: days; Epiglottitis: hours
Croup vs. Epiglottitis which has prodromal cold?	Croup
Croup vs. Epiglottitis, who has a cough?	Croup
Croup vs. Epiglottitis, who is able to drink?	Croup
Epiglottitis vs. Croup, etiology?	Croup is viral and Epiglottitis is bacterial
Epiglottits vs. Croup, who has drooling?	Epiglottitis
Croup vs. Epiglottis, which has a high fever?	Epiglottitis
Croup vs. Epiglottitis, which looks unwell?	Croup
What is the TX for epiglottits?	Abx: cefuroxime
What is the CP for Bronchiolitis/ RSV?	Dry cough, Apnea, Tachypnea, Tachycardia, Retracting, Flaring, bobbing head, Wheezes, rales, cyanosis
**What is diagnostic evaluation for bronchiolitis?	RSV Prep, Pulse oximetry, Chest x-ray looking for hyperinflation or atelectasis
**What is the Tx for bronchiolitis?	Hospitalization often, contact isolation, fluids via IV/ NG tube, humidified O2
What children are most at risk for bad complications w/RSV?	Hx of prematurity, Congenital Heart Dz, Underlying lung dz, immune deficiency, severe neuromusclular dz
What is the CP of Sinusitis?	Pain, welling, and tenderness over the cheek fr. infection of the maxillary sinus
What is the Tx for Sinusitis?	Abx and analgesia
What is the CP of aspiration of a foreign body?	Sudden onset of respiratory distress after choking on peanut, candies, or having a toy in the mouth; Choking, Cough, Wheeze, Stridor, Dec. breath sounds
**What is the diagnostic evaluation of aspiration of a foreign body?	Chest x-ray on lateral decubitus during INSPIRATION and then EXPIRATION; Broncoscopy; Usu. in Right Mainstem b/c of more direct communication
**What is the hallmark for a foreign body aspiration?	The lung remains aerated
When do you treat the swallowing of a foreign body?	When lodged in esophagus @ thoracic inlet
What is the diagnostic evaluation for FB?	CXR, KUB, Endoscopy
What is the CP of pneumonia?	Fever, difficulty breathing often preceded by a UR, cough lethargy, poor feeding
What agent in Pneumonia would cause localized chest/ ab or neck pain?	Bacteria
What is the diagnostic evaluation?	Chest x-ray, but can't differentiate bet. bacterial and viral
What is the MC agent for pneumonia in newborns?	Group B strep
What is the MC agent in infants and you kids?	RSV
In kids over 5 what is the MC agent for pneumonia?	Mycoplasma pneumoniae
What is the indication for hospitalizing for pneumonia	Indications for admission of on oximetry <93%, sever tachypnea, difficulty breathing, grunting, apnea not feeding
What is the TX for pneumonia in newborns?	Broad spectrum Abx
What is the Tx for pneumonia in older infants?	Oral amoxicillin or if a complicated pneumonia, co-amiclav
For children over 5 what is the TX for pneumonia?	Erythromycin
**What is the CP for mono?	Fever, malaise, and severe fatigue (big clue), tonsillitis, lymphadenopathy, hepatosplenomegaly, atypical lymphocytosis (huge T cells)
What is the Et. of Mono?	Epstein Barr virus
How long do sx's persist for mono?	1-3 mos.
How do you Dx mono?	Monospot or EBV titers
How do you TX mono?	Supportive TX
What is the CP of Acute Otitis Media?	MC @ 6-12 mos. of age, child pulls at ear and is irritable
What should every child w/ fever have checked?	Their TM
What does the TM look like in acute Otitis Media?	bright red and bulging w/ loss of normal light reflex
What are is the MC viral pathogen of Otitis Media?	RSV
What is the MC bacterial pathogen of Otitis Media?	Pneumococcus
What percent of Otitis Media resolves on its own?	80%
**What is the TX for otitis media?	Amoxicillin is the TX of choice
Do Abx lessen the pain assoc. w/ otitis media?	No
What percentage of kids suffer from recurrent otitis media?	20%
What is classified as recurrent otitis media?	>3 episodes in 6 mos. or >4 episodes in 12 mos.
What is the CP of Recurrent Otitis Media?	Usu. asymptomatic, may have decreased hearing
What is the TX for recurrent Otitis Media?	May req. myringotomy
How can recurrent Otitis Media be prevented?	Via breast feeding, no bottle propping, smoke free environment, prophylactic Abx
What is the CP of Otitis Media w/ Effusion?	AKA Serous Otitis Media or glue ear: TM dull, retracted, often w/ fluid level or bubbles
How OME diagnostically evaluated?	Tympanogram - the TM does not move when normally it would
When should an ENT get involved in the care of a child w/ OME?	If it persists >3-6 mos. b/c then need audiogram
What is the TX for OME?	Myringotomy and ventilation tubes
What is the biggest cause of conductive hearing loss	OME
**What are complications of Otitis Media?	Perforation, Hearing Loss, Lang. delay, Mastoiditis, Intracranial abscess
**What is the CP of Varicella?	Fever, rash that spread from face/scalp to trunk and extremities; new lesions can appear for 7-10 days; "dew drop on rose petal" vesicles, papules, crusts
How long are pts. w/ varicella contagious?	All dried and crusty are still contagious
What are some complications of varicella?	RED PES - Reyes, Encephalitis, Dehydration, Pneumonia, Encephalitis, Superinfection w/ staph and strep
What is the incubation period of varicella?	14 days
**What is the CP of measles?	Cough, Acute Rhinitis, Fever, conjunctivitis, koplick spots, rash on the 3rd day
**How do Measles spread?	Erythematous mac/ papular rash around neck, face and ears, as well as arms and chest, on day 2, rash reaches lower extremities, day 3 rash reaches feet
What are complications of Measles?	POE - Pneumonia, Otitis Media, Encephalitis
What is the TX for Measles?	Symptomatic; if hospitalized, need isolation; ribavirin is used in immunocompromised pts.
How is Varicella zoster spread?	by Respiratory route
What vasculitis can varicella cause?	Purpura fulminans
What is the incubation period of Rubella?	15-20 days
What CP for Rubella?	mild URI, low grade fever, mac/ pap rash: forehead to face
Is the Rubella rash itchy?	No
How long does it take for the Rubella rash to go away?	2-3 days
What happens if a mother is pregnant and gets infected w/ Rubella?	Blueberry Muffin baby, Microcephaly, Congential cataracts
What causes Fifth Dz?	Parvorirus B 19
**What are the sx's of Fifth dz?	mild URI, low grade fever, slapped cheek and lacy retic. rash on neck, trunk and Extremitis
What are complications of Fifth dz?	Fetal hydrops (accum. of serous fluid in fetal tissue), arthritis, anemia
What is the CP of Roseola?	High fever for 3-4 days; after deferverscence, rash occurs; sm. pink blanchable mac/ papules on trunk/ neck
What is the Et. of Roseola?	Human Herpes Virus 6&7
What are the complications of Roseola?	Febrile seizures
What is the Et. of Hand-foot-Mouth Dz?	Coxsachie virus
**What is the CP of Hand-Foot-Mouth?	Ulcerative pharyngitis is the Hallmark: URI sx's, low grade fever, +/- ab pain, vesicular/ pustular lesions on palms/ soles
What is prominent in Rubella?	Lymphandenopathy esp. suboccipital and post auricular nodes
What is the MC cause of gastroenteritis in babies?	Rotavirus
What is the MC bacterial source of gastroenteritis?	E. Col 0157 H7
What is the MC source of protozoal gastroenteritis?	Giardia Lambia assoc. w/ daycare outbreaks
What labs can be done for diarrhea?	Stool polys, culture, rotazyme, giardia antigen
What is the TX for diarrhea?	Determine degree of dehydration, Pedialyte, WHO formula, Antibx questionable
Should antimotility drugs be used for diarrhea in babies?	Nope
**What is the most common chronic non-specific cause of persistent loose stools in preschoolers?	Toddler diarrhea (peas n carrots syndrome)**
What causes toddler diarrhea?	Underlying materational delay in intestinal motility
**What is the typical CP of a child with toddler diarrhea?	Preschool kids that are well and thriving w/ no precipitating dietary factors
What is the Et. of constipation?	Can follow an acute febrile illness or forceful potty training, psychological stress, associated pain; Organic causes are rare, but can include: hirschsprung's dz, hypothyroidism, hypercalcemia
What diagnostic evaluation should be done?	PE: many times an abdominal mass found, on DRE, stool present down to the anal margin
What advice should you give parents of a child that now has a distended rectum secondary to constipation?	That soiling is involuntary and that recovery of a Nl. rectal size may take a long time
What is the CP of constipation?	Soiling, secondary soiling problems
What should be done for mild cases of constipation (feces not palpable per abdomen)?	Increase dietary fluid and fiber; may need stool softner or laxatives
What must be done in severe cases (feces palpable per abdomen)?	1st: evacuate the overloaded rectum completely; 1-2 weeks of stool softner, lg powerful laxatives, oral macrogol solutions given daily til stools are liquid; improve fluid intake; follow this w/ daily evening doses of stimulant laxative; reg sched bm
What is the Et. of GERD in babies?	Fxnal immaturity of the LES & short intra-ab length of esophagus
What is the CP of GERD?	Vomiting/ regurgitation
**How do you TX a mild, uncomplicated reflux?	Dx clinically & treat w/ thickening agents, position head @ 30 degree prone position after feeds
**How do you Dx a complicated GERD case?	24 hr esophageal pH monitoring; contrast studies of upper GI to exclude anatomical abnormalities
What are complications of GERD?	Pain, bleeding, Fe def., pneumonia secondary to pulm aspiration; peptic stricture, Sandifer's syndrome, apnea
What is the TX for severe GERD?	PPI, fundoplication
What is the CP for colic?	inconsolable crying for hrs, baby draws up knees, usu. in evenings
What is the TX for colic?	in persistent an empirical 2 wk trial of cow's milk free diet followed by a trial of anti-reflux meds
What is the Et. of UTI & vesicoureteral reflux	Often associated w/ GU anomalies: posterior urethral valves, ureterocle, abNl. implantation of ureters
What do GU anomalies lead to?	Vesicoureteral reflux
**What diagnostic evaluation is done for UTI?	Culture, Renal sonogram, voiding cystourethrogram
What TX do recurrent UTI's req.?	Prophylactic Abx's
What are longterm complications of UTI?	Renal scarring & HTN
What can chronic/ recurrent ab pain of childhood be attributed to?	IBS, Ulcer dyspepsia, or abdominal migraine, Anxiety
What diagnostic evaluation should be done for chronic/ recurrent abdominal pain?	Hx, PE (while parent observes to provide reassurance), urine microscopy and culture to r.o. UTI
What is the CP of meningitis?	Bulging fontanelle (intercranial press. inc'd); fever, lethargy, irritability, poor feeding, vomiting, apnea, cyanosis
What do you do to evaluate for meningitis?	Spinal tap - CSF: run for WBC (0-7 nl); Prot (5-40 nL); Glucose (40-80 nl); CSF/Blood glucose - 50%
What happens to CSF if the meningitis et. is viral?	Elevated WBC (mostly lymphocytes), nL protein, nL glucose
**What happens to blood count if Bacterial et. for meningitis?	very increased WBC (mostly polys), increased prot., dec. glucose
How is viral meningitis TX'd?	supportive at home or hospital
**How is bacterial meningitis TX'd	Steroids to dec. risk of hearing loss, IV Abx while awaiting C&S, IV fluids
What is the MC bacterial pathogen for babies under 1 mo. of age for meningitis?	GBS; 1-3 mos.: GBS; 3 mos+: S. pneumoniae
What are the MC pathogens of Sepsis in pt less than 1 mo. old?	E. coli
What is the et. of sepsis in pt. 1-3 mos. old?	GBS
What is the MC sepsis pathogen in pts. over 3 mos.?	S. pneumoniae
What is the risk of sepsis?	septic shock
What pathogen has the highest risk of septic shock?	Meningococcus
What is the CP of sepsis Pt.?	FLIP VAC - Fever, Lethargy, Irritability, Poor feeding; Vomiting, Apnea, Cyanosis
If a pt. under 2 mos. of age presents w/ a fever over 100.5, what should be done?	Get a full sepsis work up
What is a full sepsis work up?	CBC w/ diff, Blood Cultures, CRP, UA & Culture, Spinal tap, CXR (if in resp. distress), Shot of Rosefen, possible hospitalization
How are E requirements calculated?	1000 kcal for 1st yr of life + 100 kcal for each year after (til age 10 for boys)
What happens to the E requirements for a boy 11 and up?	1000 kcal + 1000kcal for 1st ten years of life + 200 kcal for ea. year past 10; therefore: 1000+ 1000+ 200= 2200 kcal.
What happens to the protein requirements as children get older?	They decrease
What are the protein requirements of a child age 0-1?	1.5 g/ kg of body wt
What are the protein requirements for a child 1-3 yrs old?	1.1 g of protein/ kg of body wt
What are the protein requirements of a child 4-13?	.95 g of protein/ kg of body wt.
What are the protein requirements for a child 14-18?	.85 g of protein/ kg of body wt.
What should be included in assessing nutrition and management of infants and children?	Feeding difficulties, Hx of chronic or acute illness, birthwt, gestational age @ birth, deviation fr. previously est. channel
What questions should be asked of the parents besides those listed in previous question?	About prescribed or self-imposed diets/ unusual food intake patterns; drugs/ meds hx (incl. nutritional supplements, prescribed meds), chronologic feeding hx fr. birth or onset of nutritional difficulty
**What are advantages of breastfeeding?	Superior nutritional composition, Providing immunologic & enzymatic components, lower cost, increased convenience, enhanced maternal-infant bonding, leaner body composition for infants @ 1 yr. of age, improved cognitive development, dec. resp/ GI infxs
What are barriers to breastfeeding?	Lack of confidence, embarrassment, fear of losing freedom, early return to wk., influence fr. family/ friends, "too strict" dietary req's
What are some advantages of formula feeding?	easily digestible protein, kcal for E & growth,fat for brain/ NS,other vitamins/ minerals needed for maintenance/ growth
What are some indications for using soy formulas?	Vegetarian family, galactosemia, Primary Lactase def., 2ndary lactose intolerance, allergenic infant
What should be given to a Pt. w/ 1mary or 2ndary lactose intolerance?	casein sensitive or noncasein sensitive formula
What is 2ndary lactose intolerance?	When child has diarrhea & shears off lining and need to re-establish it
Why should special formula be given to babies born at <34 wks gestation?	b/c they need a more calorie dense formula: Enfamil Premature Lipil, Similar Spec. Care Advance or Similar Neosure Advance
What should an infant formular of a healthy term baby contain?	iron
What is a contraindication for soy formulas?	For routine feeding of premature, lbw, or CF infants, management of clinical allergic rxn to cow's milk protein, routine management of colic
When should a formula w/ low phosphorous/ low Na be given?	When baby has renal dysfunction
What is a low phosphorous/ low Na formula?	Similac PM 60/40
What supplement should be given to pts. given Similar PM 60/40?	Iron - it does not contain it
What type of formulas are Portagen, Pregestimil, Similac Alimentum Advance?	Med. chain triglyceride formulas
Who need to have Portagen, Pregestimil and Similac Alimentum Advance?	babies w/ steatorrhea, sever intractable diarrhea
What can DHA/ Arachidonic acid help w?	Visual/ motor development
What formulas contain DHA/ AA?	Similac Advanced Enfamil Lipil
**Why is nonfat and 2% milk not recommended in children under 2? When can children begin having whole cow's milk?	b/c of inadequate calories/ increased renal solute load; Begin: 12 mos.
How many breastfeedings does a child on day 3 thru 1 mo. need?	10
What techniques should be employed to promote desirable eating patterns in kids?	Be in command of food available to preschool child, decide which food pattern they wish to pass on to the child, re-pattern eating habits
How should breast and formula babies be fed?	Respond to cues for hunger, satiety, and discomfort, allow the child to control the pace of feeding, use gentle touching, speak to the child during the feedings
What solid food are children typically introduced to first?	iron fortified cereals
At what age are solids introduced?	4-6 mos.
What solid foods can breast fed babies be started on instead of cereal?	Meat
What causes Toddler's diarrhea?	Excessive fruit juice (esp. apple/ pear); excessive fluids, low fat diet, sugar free candy
What is the TX for Toddler's diarrhea?	appropriate diet for age, whole milk, min. juice, no other sweet drinks; extra fat added to diet
How can obesity be handled?	Lifestyle changes: don't skip meals, make changes slowly, sched. meal/ snack times; plan family oriented activities; 5,4,3,2,1
What are the goals of Tx in management of an obese child?	maintain the current wt til growth in ht. catches up, wt. loss w/o adverse health effects; wt. maintenance w/ in nL growth curve
Define clinical epidemiology	Focused on the pts.; To study the frequency/ distribution of the dz & its risks
What does clinical epidemiology do for pediatric prevention programs?	Through comparisons and studies, intervention and evaluation is done - recommendations are undertaken and public prevention begins
What are examples of public prevention?	Chlorination/ fluorination of public water, lead regulations
Describe the purpose of pediatric screening	To i.d. pop @ risk; morbidity/ mortality should be substantial (no flat foot screening!), TX should be available, tests should be accurate
When should children be screened for lead toxicity?	At 9-12 mos. & again @ 24 mos. til community risk known
What groups are at high risk for lead toxicity?	If low income, inner city, recent immigrants w/ leaded gas, exposure to glazed pottery, metallic trinkets, toys, adults employed in high lead exposure jobs
What is the CP of lead poisoning?	PPICCAA - Pallor, Pica, Irritability, Colicky, CNS Sx's, Anorexia, Abd. pain; Failure to thrive, Lead lines at metaphyses, Delay in mental development, Hypochromic anemia
What can lead poisoning lead to?	Low levels: 10-15: dec. IQ, Impaired neuro development, dec. hearing, growth inhibition
What do levels of 25-55 of lead lead to?	severe CNS, renal, or hematopoetic syst.
What vaccine is given at birth?	HBV-1
What vaccines are administered at 2 mos.?	DR HHIP - Dtap, Rota 1, HBV-2, Hib-1, IPV-1 (inactivated polio virus), PCV-1 (pneumococcal)
What vaccines are administered at 4 mos.?	DR HIP - Dtap 2, Rota 2, Hib-2, IPV 2, PCV 2
What vaccines are administered @ 6 mos.?	DR HHIP - Dtap 3, Rota 3, HBV 3, Hib 3, IPV 3, PCV 3
**What vaccines should be administered at 12-15 mos.?	DIP and MMR,Varicella and Hep A: Dtap, IPV, PCV
What advice should be given to parents about poisoning?	Do NOT induce emesis
What is the TX for all poisonings?	ABC's, activated charcoal
What is the MC cause of death for children 6-12?	Accidents
What are newborns screened for in Texas?	Galactosemia, Thyroid dz, RPR, PKU, Hemoglobin type
What vaccines are given at 15-18 mos.?	Dtap 4 (IF NOT GIVEN AT 12 Mos.), HAV 2
What vaccines are administered to 4-6 y.o.?	Dtap 5, IPV 4, PPV, MMR 2
What vaccines are administered to 11-12 y.o.?	Tdap, HPV, MCV 4
What risk group should receive flu shot yearly?	children under 6 mos, those w/ lung or heart dz, sickle cell, HIV, DM, PPV, MCV4 and if under 2 and asplenia
What are valid contraindications for all vaccines?	Anaphylactic rxn to vaccine or components, moderate or severe illness
Is a PCN allergy a valid contraindication for vaccines?	No
When is DTaP contraindicated?	If after last vaccine, pt. had encephalopathy w/ in 7 days; fever of >105 w/in 48 hrs, collapse/ shock or seizure w/in 3 days, crying inconsolably >3 hrs w/in 2 days of vaccine
**What are contraindications for MMR, Varivax,or any attenuated live virus?	Recent immunoglobulin, Immunodeficiency, Anaphylaxis to eggs
What is the CP for SIDS?	Unexpected and unexplained death of a child under 1
What is the peak incidence of SIDS?	2-4 mo.
When is SIDS rare?	prior to 4 wks of life and after 6 mos.
What is the leading cause of death of children 1 mo. to 1 yr?	SIDS
What causes SIDS?	Unknown
What are RF for SIDS?	Correlation bet. fetal hypoxemia and poor prenatal care; Maternal smoking, drug use, low ed level, single moms, multiparity, young aged mom, anemia, UTI, STD
What are neonatal RF for SIDS?	TRIPP to BC, FA, HA: Tachypnea, Resp distress, Irritability, Poor feeding, Prone sleeping, Bradycardia, Cyanosis, Fever, Apnea of Premarurity, Hypothermia
What are newborn RF for SIDS?	NA SAMPPLL: Native American, Sm. for gestational age, African american, Male, Prone sleeping, Prematurity, Lack of breastfeeding, Low birth weight
What can dec. RF for SIDS?	Supine sleep position, appropriate bedding, good prenatal care, home monitors for infants w/ increased risk (apnea), no bed sharing, no smoking
What is the CP for Apparent Life Threatening event?	Apnea w/ color change, dec. M. tone, choking/ gagging
What is the usu. age of baby facing ALTE	less than 6 mos. peaking at 8-14 wks
What are potential causes of ALTE?	DAM CRAS GUS M!- Drugs, Abuse, Muschausens, Cardiac, Respiratory disorders, Apnea of Prematurity, Seizures, GER, Upper Airway Obstruction, Sepsis, Metabolic
What should be asked during evaluation of ALTE?	Detailed description of event: how was baby breathing? heart beat? how long did it last?, was baby awake or asleep? have there been changes in feeding? color changes? bizarre movements? Hx of prematurity, seizures, bronchopulmonary dz, GER
What PE should be done in evaluation of ALTE?	General appearance, Vital signs (are they stable?), Pulse Ox, HEENT (bulging or sunken fontanel?, neck -is there stridor, ridgity?), chest (murmur? breathing labored?, and Neuro (is child listless, lethargic,socially engaging?
What labs should be run in evaluation of ALTE?	CBC, blood cultures, electrolytes, UA, EKG, EEG, CXR, pH probe, CT/ MRI
How do you manage a well appearing child (on PE and unremarkable Hx) after ALTE?	Reassure and things to watch for
What are significant findings in ALTE?	Cyanosis, Req. vigorous stim., Ill appearing
How should a baby with significant ALTE findings be managed?	Admit for observation/ wk up (cardiac monitors, respiratory monitors)
What is the CP of reye syndrome?	Prodrome of viral illness; recovery pd. followed by Vomiting, Irritability, Lethargy, Delirium, Stupor, Seizures, Coma
What is the dx evaluation of reye syndrome?	Hx of ASA use during viral like illness
What labs should be run for pt. suspected of reye syndrome	U LEGALL PACC - UA, LFT, EEG, Glucose, Amino acids, Lipase, LDH, PT/PTT, Amylase, CSF, CT
What Bx can be done on a pt. suspected of reye syndrome?	liver
What is the TX of Reye syndrome?	monitor LFT's, Lytes, VS, PE, manage intercranial pressure, coagulopathy, seizures; perform dialysis for high ammonia levels
What is most important about Reye syndrome?	Preach prevention; inform teens not to take ASA, don't take certain acne TX's
What are organic causes of Failure to Thrive?	GRIMM CEN - GI, Renal, Infectious, Misc., Metabolic, Cardiopulmonary, Endocrine, Neuro
What neuro dzs can cause FTT?	cerebral palsy, mental retardation
What GI dzs can cause FTT?	GER, malabsorption, structural problems, food intolerance
What renal dzs can cause FTT?	UTI, RTA, diabetes insipidus
What infections can cause FTT?	HIV, TB
What metabolic disorders can cause FTT?	inborn errors of metabolism
What misc. things can cause FTT?	lead poisoning, malignancy
What cardiopulmonary dzs can cause FTT?	bronchopulmonary dz, CF, CHD
What endocrine dzs can cause FTT?	DM, hypothyroidism, growth hormone deficiency
What does FTT cause?	Developmental delays and poor psychosocial functioning.
What are inorganic causes of FTT?	Parents not offering adequate calories, child not taking in adequate calories, failure of child to retain calories
What is the CP of FTT?	No linear growth, wt. loss, loss of cutaneous fat, skin/ hair problems, recurrent infection, hepatomegaly, developmental delays
What other factors should go into evaluation of FTT?	Parent/ child interaction
What labs should be run on a pt. w/ FTT?	HIV, TB, UA, TSH, Glucose test, Sweat test, lytes, organic and AA's
How should FTT be managed?	Must be team approach bet. clinician, social worker, nutritionist, child life specialist, address any organic concerns, provide a high cal diet, keep food diaries, do freq. wt. checks, limit juice; give solids before liquids
What are some congenital GI abnormalities?	Congenital duodenal obstruction, Hirschsprung dz, Pyloric stenosis, Volvulus
What is the CP of Congenital duodenal obstruction?	assoc. w/ trisomy 21, bilious vomiting, lethargy, abd. distention, respiratory difficulty
What is seen on KUB for duodenal obstruction?	Double bubble sign, dilated loops of bowl
What is the TX for duodenal obstruction?	NG tube, IVF, surgery
**What is the CP of Volvulus?	Bilious vomiting w/ in 1st wk of life is volvulus til proven otherwise
What is seen on Upper Gastrointestinal series?	Spiral sign
What can be seen on sonogram for a pt. w/ volvulus?	malpositioning of the superior mesenteric vessels
What is the TX for volvulus?	NPO, NG tube (to clean out gut), IVF, Abx, Surgery
**What is the CP for Hirschsprung dz?	CONSTIPATION, meconium ileus, FTT, abdominal distention, LLQ mass (stool), intermittent vomiting
What is the DX for hirschsprung dz?	KUB, barium enema, Bx
What is the TX for hirschsprung dz?	Surgery
What is the MC cause of obstruction in a neonate?	Pyloric stenosis
What gender does hirschsprung dz and pyloric stenosis affect most and by what ratio?	Males - 4:1
**What is the CP of pyloric stenosis?	NON bilious projectile vomiting, pt. usu. less than 28 days old; hungry pt. who wants to eat again, wt. loss, dehydration, metabolic alkalosis, OLIVE Shaped mass, L to R peristaltic waves after feeding
How is pyloric stenosis Dx'd?	Via Hx & ultrasound, UGI if US inconclusive
What is the TX for pyloric stenosis?	Surgery
What is the MC cause of obstruction in kids 3-6 mos. old?	intussusception
What is the et. of intussusception?	Unknown
What is intussusception associated with?	Lymphadenopathy, polyps
What direction does the peristalic wave move in for pyloric stenosis?	Left to right
**What is the CP for intussusception?	Sausage shaped mass, bloody stools, shock, colick, fever, lethargy
What does constriction due to intussusception lead to?	engorgement, edema, and bleading
How is intussusception Dx'd?	Via Hx, PE, KUB, air/ contrast enema
**What test is diagnostic and curative for intussception?	air/ contrast enema
What is the TX for intussception?	IVF, NG tube, reduction via air or barium contrast enema, surgery if perforation or unable to reduce
What is occult bacteremia?	Fever of unknown origin
What is the CP of occult bacteremia?	A (+) blood culture in a well appearing child w/ fever, but no obvious infection signs
What are the common pathogens for occult bacteremia?	S. pneumoniae, Hib, N. meningitidis
What can occult bacteremia progress to?	SPAM CO - Sepsis, Pneumonia, Arthritis (septic), Meningditis, Cellulitis, Osteomylitis
What should be asked during evaluation of occult bacteremia?	Does child go to daycare? Anyone sick at home; Get appropriate contact #'s
What other things should be done to evaluate occult bacteremia?	CBC w/ diff, blood culture, UA w/ micro & culture, CXR to r.o. pneumonia, CSF to r.o. meningitis
When can occult bacteremia be Tx'd @ home?	If parents are reliable, if child looks good and how high WBC is
What supportive care can be given for occult bacteremia?	24 hr follow up and tylenol or motrin
What Bx can be given for occult bacteremia?	IM cephalosporin or PO amoxil
What children should be admitted for bacteremia?	for toxic appearing child and child upder 3 mos. of age
What is enuresis?	Involuntary passing of urine in a child above 4
What are possible et. of enuresis?	Sm. bladder capacity, sleep arousal disorders, Psychosocial, Organic causes such as DM, UTI, Constipation, neurogenic bladder, ectopic ureter
What PE should be done for pt. w/ enuresis?	DTR's, inspect genitalia for evidence of abuse, take bp, check S2-S4
**What is the TX for enuresis?	enlist child's participation; protect the mattress, have (+) reinforcement, void q 2-3 hrs. while awake, bedwetting alarms, Ditropan Levsin, Detrol
What is encopresis?	Involuntary passage of stool
What should be on the DDx for encopresis?	hirschsprung, hypothyroidism, CNS disorders, GI dz
What is the cycle involved in encopresis?	constipation->retention->colon dilatation-> overflow
What should be done to evaluate encopresis?	PE, stool O&P/ culture, KUB
What is the TX for encopresis?	evacuation via enemas, laxative, stool softeners, bathroom regimen, high fiber diet, counseling (to r.o. psychosocial issues
**What is the CP of Wilms Tumor?	AACFFHHM - Anorexia, Ab pain, Constipation, Flank mass, Fever, Hematuria, HTN, Malaise (MANY times simply an asymptomatic flank mass)
What antenatal screening measures are commonly performed on newborns?	Serum alfa fetoprotein, Amniocentesis, Fetal US, Maternal screening for: GBS, HIV, Hep B, Rubella, Syphillis
What does serum alfa fetoprotein test?	Neural tube defects, gastrochisis, polycystic kidneys
What is an amniocentesis used for?	To detect chromosomal abnormalities like trisomy 21, 18, 13
What does a fetal US detect?	assess fetal growth, and eval. heart and kidneys
If a mother has hypothyroidism, what happens to the baby?	Can be born with hypothyroidism
If a mother is hyperthyroid, what happens to the baby?	Transient thyrotoxicosis
If the mother has HTN during pregnancy what happens to the baby?	IUGR
If a mom has myastheniaGravis, what happens to the baby?	transient myasthenia
If a mom has systemic lupus, what effect can that have on the baby?	C. SCRANT: Congenital heart block, Stillbirth, Cardiomyopathy,Rash, Anemia, Neutropenia, Thrombocytopenia
**What are the effects of Gestational diabetes on the newborn?	low: CaGluMg, high RBC, LGA, birth asphyxia, shoulder dystocia, brachial plexus injury
**What congenital anomalies are common in infants of pre-pregnancy diabetic mothers?	cardiac or sacral agenesis
What effect does maternal intake of anti-epileptic meds have on infants?	CM, CM, & LM - Cardiac malformations, CNS, Midface hypoplasia, Limb Malformation
What effect does Vit A/ Retinoids (Accutane) have on infants?	Abnl face or miscarriage
What effect does Tetracycline intake by mother have on infant?	stained teeth
What effect does lithium intake by mother have on infant?	congenital heart dz
What effect does DES have on infant?	adenocarcinoma of the vagina or cervix
What effect does Thalidomide have on infant?	phocomelia - limb shortening
What effect do Iodides or PTU maternal intake have on infants?	hypothyroidism
What effect does maternal intake of cytotoxic agents have on infants?	congenital abnormalities
What effect does maternal intake of Nicotin have on the infant?	SGA due to placental insufficiency
What effect does maternal ETOH intake have on an infant?	Fetal Alcohol syndrome - characteristic facies, cardiac, developmental delay, and growth restriction
What effect does maternal cocaine consumption have on the baby?	Placental abruption in preterm delivery
What sx's does a child of a mother abusing opiates, methadone, and heroin have?	Yawning, sneezing, jitterness, vomiting, diarrhea, poor feeding, wt. loss
What does C-section increase the risk of?	Transient tachypnea
What does an Apgar score of 0-4 indicate?	Severe depression
What does an Apgar score of 8-10 represent?	Nl.
What are the factors measured in the Apgar score?	Activity (M. tone), Pulse, Grimace (response to cath under nose), Appearance (color), Respiration
What is a normal hr for newborn?	over 100
How is GC conjunctivitis prevented?	w/ 1% silver nitrate
Why are newborns given a shot of Vit. K?	To prevent hemorrhagic dz of newborn secondary to vitamin K def.
What are the elements of a neonate physical exam?	Vital signs monitored, general appearance noted to include wt., lenght, Frontal occipital circumference, activity and level of cousciousness, bp, rr, temp
What is the 1st thing to notice when performing an infant exam?	Observe feeding and interaction w/ parents
Where should most of the exam on a baby be performed?	on the parents lab
Should the baby be undressed prior to beginning exam?	Nope, as it progresses?
When should the lungs and heart be listened to?	At the beginning, while baby still quiet
When should eyes be examined?	When baby spontaneously opens eyes?
When should the skin exam be performed?	As you go along
What exam in an infant is performed last?	Hip Exam
What is acrocyanosis?	Blue cast of extremity when exposed to cold
Does acrocyanosis require TX?	Nope resolves on own in couple of wks
What is cutis marmorata?	Lattic like, bluish mottled appearance
What causes cutis marmorata?	nerve supply instability to the capillary vessels
How is jaundice tested?	Press the color from the skin and see if yellow or white
What is Plethora?	Too red
What does plethora indicate?	Polycythemia
What does petechiae indicate?	Trauma or infection
What is Vernix caseosa?	Sebum
What is a capillary hemangioma?	Stork bite if at nape of neck or angel kisses if in forhead, upperlip or eyelids
What is does a Port Wine stain possibly indicate?	Sturge-Weber syndrome if at trigeminal N.
What is Sturge-Weber syndrome?	Can cause seizures, hemiparesis, glaucoma, MR
Are mongolian spots common in caucasians?	No
Where are mongolian spots commonly found?	Lower lumbar region
**What is Miliaria rubra?	Heat rash - it is due to blockage of sweat ducts - common in babies living in hot, humid climates
What is erythema toxicum?	Erythematous macules w/ central pinpoint vesicle
**What is pustular melanosis?	Veisculopustules over brown macular base
How big is the anterior fontanelle and when does it close?	4-6 cm and closes betw. 4 and 26 mos.
What is the size of the posterior fontanelle and when does it close?	1-2 cm, closes by 2 mos.
What does a bulging fontanelle signal?	increased ICP
What is synostosis?	Premature fusion of the sutures
What is craniotabes?	Feels like a ping pong ball
What does craniotabes indicate?	Rickets, congenital syphillis or hydrocephaly
What is caput succedaneum?	Edema from birthtrauma - cone head, crosses suture lines
How long does it take for caput succedaneum to resolve?	2 days
What is cephalohematoma?	Subperiosteal bleed; does not cross suture line
How long does a cephalohematoma take to resolve?	About 3 wks
What does upslanting palpebral fissures signal?	Down's syndrome
What does downslanting of palpebral fissures signal?	Noonan's Syndrome
What do short palpebral fissures signal?	Fetal Alcohol effects
What does a white reflex (leukokoria) instead of a red reflex signal?	Cataracts, retinoblastoma, chorioretinitis, retinal detachment
What should be done for persistent ocular discharge or tearing?	Massage it til lacrimal duct pops open
What does retinal hemorrhage indicate?	Trauma, intracranial bleeding
What is clobomas?	Key like defect in iris
What is heterochromia?	Diff't colored eyes
what can small, deformed or low set pinna indicate?	Congenital defects, esp. renal dz
What are preauricular cysts assoc. w/?	Hearing loss
How is hearing checked?	By startle response and blink
Why should nares be patent in infants?	babies are obligate nose breathers
What are epstein pearls?	Cysts along the alveolar ridge
Will espstein pearls disappear on their own?	Yes in 1-2 mos.
What is a branchial cleft cyst?	small dimples anterior to SCM
What is congenital torticollis?	A firm fibrous mass in SCM
What is a cystic hygroma?	congenital cyst posterior to SCM
What can cause breast nodules in newborns?	Maternal hormones
What is the normal rate of respiration in newborns?	30-40/ min.
Who tends to have irregular breathing?	Common in newborns, esp. preemies
Is periodic slower breathing and occasional apnea up to 5-10 sec.normal in newborns?	Yes
What is true apnea?	Over 15 sec.
What type of breathing do neonates do?	Diaphragmatic
What are signs of respiratory distress?	Retractions, flaring nares, grunting, wheezes, stridor
How can central cyanosis be checked?	Check tongue, normal is strawberry pink, if raspberry pink - desaturation signaled
What is a normal at rest HR for newborns?	Aprrox. 90
What is a normal active HR for newborns?	180
What is coarctation?	Absence of femoral pulses
How often should bp be checked during new born period?	1 time
What is the systolic pressure at birth?	70
What is systolic pressure at 1 mo.?	85
What is systolic pressure at 6 mos.?	90
**What are characteristics of innocent murmurs?	Normal heart sounds with no S3, S4, No diastolic component, No parasternal thrill, No radiation; Soft blowing, Left Sternal edge, pt. asymptomatic
Why does congenital heart dz sometimes not present until several wks pass?	b/c they present when pulmonary vascular resistance falls
What is the most common type of congenital heart defect?	Ventricular septal defect
**What are features of sm. Ventricular septal defects?	ATLN - Asymptomatic, Thrill @ lower sternal edge, Loud pansystolic murmur at lower LSB, Nl. CXR and EKG
What can a lg. VSD cause?	heart failure b/c of FTT in the 1st wk of life
What are sound features of a lg. VSD?	Soft pansystolic murmur (or no murmur) or a mid-diastolic murmur
What is loud in a lg VSD?	S2
What can be seen on CXR for a lg VSD?	Cardiomegaly, enlarged pulm arteries
What is seen on ECG for a lg. VSD?	biventricular hypertrophy
Is an atrial septal defect symptomatic or asymptomatic?	Usu. asymptomatic
What is heard in an Atrial Septal defect?	A fixed, widely split S2
What type of murmur is involved in an Atrial Septal Defect?	Systolic murmur
Where is the systolic murmur of an Atrial septal defect best heard?	@ upper LSB
What type of murmur is heard with a patent ductus arteriosus?	Continuous, machinery murmur beneath (L) clavicle
Why are ppl with tetralogy of fallot cyanotic	b/c of the Right to left shunt
**What are the four malformations found in tetralogy of fallot?	PROV: Pulmonary Stenosis, Right ventricular hypertrophy, Overriding Aorta, VSD
What type of murmur is heard in a tetralogy of fallot?	Loud, harsh single S2 murmur
**Does an umbilical hernia require surgery?	Only if not resolved by age 2; only observation until then
Where can the liver be found in a newborn?	1-2 cm from the right costal margin
Should kidneys be palpable in newborns?	Yes
**In what timespan should meconium be passed?	by 12 hrs
How should an umbilical hematoma be treated?	zap at base w/ silver nitrate
Is foreskin retractable at birth?	No
Do hernias transiluminate?	No
How common is adrenal hyperplasia?	1 in 5K births?
What is adrenal hyperplasia due to?	Deficiency in 21-hydroxylase
What is 21-hydroxylase needed for?	for cortisol and aldosterone synthesis
What does a low cortisol cause?	high ACTH
Why is a high ACTH harmful to fetus?	causes over production of adrenal androgens
What does high levels of adrenal androgens cause in females?	virilization of female external genitalia
What does high ACTH cause in males?	increased size and excessive pigmentation of scrotum
What happens to 80% of those who make no aldosterone?	Salt losing crisis
How is adrenal hyperplasia managed?	Glucocorticosteroids and possibly mineralcorticoids
What percentage of neonates void by 24 hrs?	95%
What kind of vaginal discharge is normal in the first few weeks of a female's life?	milky blood tinged discharge
What is the Barlow test?	Provocative test to see if you can dislocate an unstable hip
What is the Ortolani test?	Method to reduce the recently dislocated hip back into place by flexing and abductinve the hip and lifting the femoral head
What does limitation of abduction of the hip indicate?	Developmental Displacia of the Hip (DDH
What type of birth runs risk of hip displacement?	Breeched
What is the Galeazzi sign?	Asymmetric thigh folds, shortening of extremities and uneven knee levels w/ supine infant's feet placed together on the bed with knees and hips flexed
What is a sign of Brachial plexus injury?	Waiter's tip
What is the moro reflex?	Startle reflex (embrace response)
When should the moro reflex go away?	At 3-6 months
What is the Asymmetric Tonic Neck Reflex	Fencer reflex
When does the ATNR disappear?	4-9 mos.
What is the parachute reflex?	Arm extension when falling
What is the purpose of the parachute reflex?	Facial protection when falling
When does the parachute reflex appear?	5-6 mos.
What is the lateral propping reflex?	Arm extension laterally in protective response.
What is the purpose of the lateral propping reflex?	It allows babies to sit independently
When does the lateral propping reflex usu. appear?	6-7 mos.
At what age does the stepping reflex disappear?	at age 2-3 mos.
What is Respiratory Distress syndrome also knowns as?	Hyaline Membrane dz
RDS is inversely proportional to what?	Gestational age
What causes RDS?	Insuffient surfactant
What is the CP of RDS?	tachypnea, apnea, show resp., hypoxia, cyanosis, fine rales, respiratory and metabolic acidosis
What is the peak time of RDS?	3 days
Is improvement sudden?	No, it is gradual
How do you Dx RDS?	CXR shows fine reticular granularity and air bronchograms, CO2 is increased and O2 is decreased
What is the TX for RDS?	Mechanical ventilation, Oxygen, tracheal surfactant, maternal steroids, supportive care
What are complication of RDS?	PIC PINS - Pneumonothorax, Interstitial emphysema, Chronic lung dz; Pulmonary hemorrhage,Intraventricular hemorrhage, Necrotizing enterocolitis, Subglottic Stenosis
**Is transient tachypnea of the newborn commonly seen in full term babies?	Yes
How long does transient tachypnea of the NB last?	recover by 3 days
What is the TX for transient tachypnea of the NB?	Minimal oxygen
Who is meconium aspiration syndrome seen in?	Full or post term infants who are born meconium stained
What does meconium aspiration cause?	Airway obstruction/ resp. distress
What should depressed infants be suctioned with?	An endotracheal tube
At what point should depressed newborns be suctioned?	Before fully out, as soon as head comes out
What is the TX for meconium aspiration?	Mech. ventilation, O2 and supportive care
What percent of term infants appear jaundiced by 1st wk of life?	60%
Is this physiological jaundice?	Yes
**When does physiologic hyperbilirubinemia appear?	at 2nd to 3rd day
**When does physiologic hyperbilirubinemia peak?	at 3rd or 4th day
**When does physiologic hyperbilirubinemia decrease?	days 5-7 in formula fed or two weeks in breastfed
What are risk factors for prolonged physiological jaundice?	cephalohematoma, bruising, polycythemia, premature, breast feeding, Asian or NA race
Why are bili levels followed?	To prevent Kernicterus
What is Kernicterus?	Neuro syndrome caused by deposition of unconjugated bili in brain cells
Is Kernicterus common in FT babies?	No
Is kernicterus rare in the absence of hemolysis?	Yes
What is the CP of a baby with kernicterus?	Poor feeding, lethargy, diminished reflexes, bulging fontanelle
What is the TX of kernicterus?	Prevention and phototherapy, possibly exchange transfusion
What are sx's of hypoglycemia?	D JAILS - Dowsiness, Jitterness, Apnea, Irritability, Lethargy, Seziures
Who are more at risk for hypoglycemia?	IDM, IUGR, prematurity, hypoxia, hypothermia, inborn errors of metabolism
What are causes for seizures?	GIN DICK HIM - Glucose decrease, Inborn errors of metabolism, Na increase or decrease; Drug withdrawal, Intracranial hemorrhage, Cerebral malformations, Kernicterus; Hypoxia, Infection, Mg;
What are CP of seizures?	Lip smacking, staring spells, tongue thrusting, Tonic extension, myoclonic jerks
How do you Dx Wilm's tumor?	RUS, Ab CT, Lytes, Creat, UA, PT/PTT, MRI
How do u TX Wilm's tumor?	Via surgery, chemo, radiation
How are pediatric heart murmurs evaluated?	Via exam - must listen sitting, standing, supine
What are the two stages of protein synthesis?	Transcription and translation
What happens during transcription?	Genetic info from DNA copied into mRNA,
What is the initial codon in translation?	AUG
Name an autosomal recessive dz.	Sickle cells anemia
What is an X-linked inheritance	Mutations on the X chromosome
Who does X-linked dominant dzs affect?	Both male and female
How many copies are needed for a male to have an x-linked recessive dz?	One
What is an example of x-linked recessive dz?	Hemophilia
What deficiency is found in hemophilia?	For factor VIII
Do polygenic/ multifactorial genes get passed down in the mendelian inheritance pattern?	No, more than one gene involved, there is familial aggregation
What else is involved in multifactorial inheritance?	environmental and lifestyle factors
What are examples of multifactorial dzs?	OH HEAD SCABS - Obesity, HTN, Heart dz, Epilepsy, Asthma, Dm, Schizo, Colon ca, Arthritis, Breast ca, Stroke
What is Locus Heterogeneity?	diff't mutations in any one of several genes can lead to the same phenotype
What is an example of Locus Heterogeneity?	Retinitis pigmentosa
What is Allelic heterogeneity?	diff't mutations on the SAME gene can cause same phenotype
What is an example of an allelic heterogeneity condition	CF
What is genetic imprinting?	Imprinting refers to the chemical modification of the DNA in some genes that affects how or whether those genes are expressed. One particular kind of DNA imprinting found in mammals is known as parental genomic imprinting, in which the sex of the parent f
What is an example of a dz caused by failure of the father's gene to go thru genetic imprinting?	Pradar-Willi syndrome
What is another example of a dz caused by failure of a gene to go thru genetic imprinting?	IGF2 (insulin-like growth factor 2)
What happens if IGF2 fails to go thru genetic imprinting?	Wilm's tumor and colon cancer
What parent's IGF2 gene should go thru genetic imprinting?	The mother's gene
What is anticipation?	Tendency of some traits to worsen in successive generation
What dzs are examples of anticipation?	Huntington's chorea, Myotonic dystrophy
What is phenocopy?	A non-genetic condition that mimics a genetic condition
What are somatic cell mutations?	Mutations that occur within a person's daughter cells, cannot be passed down to children
Are germ cell mutations heritable?	Yes
What is considered a large scale mutation?	Gain/ loss of chromosomal region
What is a small scale mutation?	Nucleotide base substitutions, deletions, insertions
What are translocations a sample of?	A large scale mutation
Is Apert syndrome Autosomal Dominant or sporadic?	Either
What type of genetic dz is Crouzon syndrome, Autosomal dominant or sporadic?	AD
What is Rhizomelic shortening?	Shortening of the proximal end of the long bones
What dz has rhizomelic shortening?	Achondroplasia
What is one of the MC chromosomal abnormalities in liveborn children?	Trisomy 21
What are some features of a child w/ Down's	F-SSHAPPED: Flat facies, Slanted palpebral fissures, Single transverse palmar crease, Hypotonic, Abn. ears (anomolous auricles), Poor moro reflex, Pelvic dysplasia, Excess skin on back of neck, Dysplasia of 5th mid phalanx
What % of children w/ trisomy 21 have MR?	100%
Why do 50-70% of pts. w/ trisomy 21 have serous otitis media?	b/c tubes are sooo tiny
What are some features of pts. w/ trisomy 18?	IUGR, clenched fists, choroid plexus cyst, rocker bottom feet, cardiac defects
What do children from Trisomy 18 die from?	FTT and apnea
What is Trisomy 13?	CHUM SPPUDS - Cleft palate, Holoprosencephaly, Umbilical a. is single, Microphthalmia, Seizures, Polydactyly, Urinary tract defects, Deafness, Sloping forhead,
Who is affected by Klinefelter's?	Men
What are some features?	Nl. intelligence (but may have psychosocial issues), gynecomastia, hypogonadism, tall and thin, infertile
What is the TX for Klinefelter's?	refer to behavioral specialist/ developmental specialist; testosterone TX in teens, FU for virilization, sex fxn, self esteem
What is Turner syndrome?	A monosomy - missing a chromosome - the X chromosome
What are clinical features of Turner's 45, X?	Short statures, Cubitus Valgus, Webbed neck, ptosis, broad chest (far set nipples), posteriorly rotated ears
Wha is a common associated finding w/ Turner's syndrome?	Gonadal dysgenesis
What vascular abnormality is found in Turner's?	Co-arctation of the aorta, bicuspid aortic valve
At what age do girls with turner's receive growth hormone?	ages 2-4
When do you stop giving Turner's pts. growth hormone and start estrogen replacement?	Adolescence
What other med is administered to Turner's kids?	Thyroid hormone
What renal anomaly do 60% of turner's syndrome pts. have?	Horse shoe kidney
What is Fragile X?	Parts of the X chromosome break off
What are clinical features of Fragile X	big head, big chin, big testes, autism, mild to profound MR
What are clinical features of Marfan syndrome?	Tall, long legs, short torso, pectus excavatum, arachnodactyly, joint laxity
Why should a slit slamp test be done on a Marfan pt.?	To check for subluxed lenses
What is a major vascular anomaly in Marfan's?	Aortic Aneurysm
What is DiGeorge syndrome?	A deletion of part of Chromosome 22
What are Sx's of inborn errors of metabolism?	in neonate: Vomiting, Anorexia, Lethargy, Seizures
What are CP of a child beyond 28 days?	Vomiting, Respiratory distress, Changes in Mental status
Do inborn errors of metabolism have special facial features?	No
What triggers the onset of the CP of inborn errors of metabolism in kids older than 28 days?	Precipitated by intercurrent dietary indiscretion, intercurrent illness, prolonged fasting
What do kids with an inborn error of metabolism have a hard time metabolizing?	Protein, fat, or sugar
What is a typical profile of a child with inborn errors of metabolism?	Child had a viral illness and is now not reaching milestones or child doing well but now in a coma
What does hyperammonemia signal?	Difficulty w/ protein digestion
What is an example of a lysosomal neurodegenerative disorder?	Hurler, Hunter syndromes
What are some clinical features of a lysosomal disorder?	Hepatosplenomegaly, Corneal clouding, Neuro deterioration
What is Peroxisomal disorders?	X-linked adrenoleukodystrophy, zellweger syndrome
What are clinical features of Peroxisomal disorders?	Seizures, Loss of milestones, Loss of white matter, hepatosplenomegaly, progressive neurogeneration and eventual death
What is the MC eye cancer in children?	Retinoblastoma
What is a CP of retinoblastoma?	Leukokoria
What are indications for referral to genetic counseling?	Known or suspected hereditary disorder: like Huntington, major physical anomalies, major organ malformation, developmental delay
What are indications for Karyotype?	Two major or 1 major and two minor malformations
What are examples of major malformations?	Sm. for gestational age and MR
What does a Nl. growth pattern look like	The child follows along their line through out
What is considered failure to thrive?	When child falls beyond two growth lines
What does a sudden drop in wt. and then return to normal growth line signal?	Acute illness
What does constitutional delay in puberty look like on a growth chart?	It looks like a curve that appears to be flattening, but then shoots up
What does an acquired growth hormone deficiency curve look like?	Sudden flattening of just the height and deceleration of growth
When is the highest risk of spontaneous abortion.	in wk 9
What are most spontaneous abortions caused by?	Genetic anomalies
What % of spontaneous abortions are caused by teratogens?	10%
What are examples of Infectious Teratogens?	TORCH(E)s - Toxoplasmosis, Other (parvo), Rubella, CMV, HSV,HIV, Hepatitis C, Syphilis
What are chemical agents that are known teratogens?	DEC MEATS - DES, Etoh, Cocaine, Mercury, Meth, Etoh, Accutane, Toluene, seizure meds
What problems arise with a mom infected w/ toxoplasmosis?	Baby blind, hepatosplenomegaly, MR
What are other sources that are teratogenic?	Hot tubs or radiation
Are growth charts biased?	Yes, ethnically and culturally
What are limitations of growth charts?	Biased
Can growth charts be used for Dx?	Nope, it is a screening tool
What do growth charts do?	I.D.'s areas of concern that prompt further testing
What are the movements of 1 mo. olds like?	Reflexive
What is a 1 mo. old's vision like?	can see the distance btw face and breast
What is a one month old's hearing like?	Mature, can recognize voices
Is a 1 mo. old's smile social?	Nope
At what age do babies typically roll over, sit, support wt.?	4-7 mos.
At what age do kids began to walk supported by furniture (or fully), develop pincer grasp, get stranger anxiety?	8-12 mos.
At what point do kids triple their birth wt?	by 12 mos.
At what point do kids attain 90% of their head size?	24 mos.
When do kids begin to socially smile?	1-3 mos.
At what point do kids recognize voices?	1 mo. old
What happens to growth at 12-24 mos.?	Slows remarkably - gain 3 to 5 pounds and grow 1.5 inches
When can kids begin to run, kick ball, climb?	12-24 mos.
At what point do kids progress from single words to phrases?	12-24 mos.
At what age do kids follow directions?	12-24 mos.
At what age do kids develop fear of monsters, sees self as a person w/ feelings, tells stories, copies shapes	2-5
At what stage can kids participate in organized activities?	5-12
At what age do kids have sleep onset assoc. disorder?	Toddlers and infants
What is sleep onset association disorder?	Inability to self soothe
At what point would you have an anticipatory discussion w/ parents about colic	At 2 week visit
What should you advise parents to do with a colicky baby?	Motion, rhythmic noise, paci, swaddle, get out of the house w/ baby, allow baby to cry
When do babies tend to have more separation anxiety?	When tired, sick or hungry
How should you instruct parents to say bye to baby w/ separation anxiety?	Without fuss- distract and say good bye. Do not drop and leave
When do walking and night terrors happen?	1st third of sleep cycle
What sleep disorders category do sleep walking and night terrors belong to?	Parasomnias
At what stage do nightmares- part of parasomnias category sleep disorders?	During REM - so last third of sleep
What age are sleep walking and night terrors more common in?	Young children
Is there a genetic predisposition to sleep walking/ night terrors?	Yes
How should you instruct a parent to handle temper tantrums?	remove child from the situation, Laugh, avoid triggers, DO NOT bribe, remain calm, give choices
Is breath holding common?	Yes in 1st few yrs of life
When does breath holding usu. occur?	during tantrums
What can breath holding lead to?	loss of consciousness
Is there increased risk of seizures w/ breath holding?	Nope
What approach would you advise parents to take regarding breath holding?	Ignore it
What is school anxiety/ avoidance?	Create situations not to go to school
When is school anxiety/ avoidance a major concern?	Pre-adolescence
How should school avoidance be managed?	Be firm, don't ask how they feel, don't make it a holiday at home, seek help if longer than 1 wk.
What should be discussed at the two week check up?	Fever- bring them in if > 1 mo., discuss feeding (I&O), safety, incl. car seat, discuss cord care
What should be discussed at 2 mo. check up?	Bed safety, roll over protection, how to care for a fever, importance of stimulation
What advise should be discussed at 4 months?	New foods, sleep changes, safety, stimulation
What should be discussed at the 6 mo. check up?	diet and safety (advise parent to get on hands and knees)
What should be discussed at the 9 mo. check up?	diet - introduce cup, finger feeding, safety - poison control, behavior management
What should be discussed at the 1 yr. check up?	Safety due to inc. mobility, stimulation via reading
At 18 mo. check up, what should be discussed regarding toilet training?	Not ready yet
What is the most frequent concern at 24 mos.	discipline
What is the avg. age of puberty onset for boys?	11
What is the avg. age of onset for girls?	9
What happens to adipose tissue in girls during puberty?	It increases
What happens to adipose tissue in boys during puberty?	Decreases
Is there a correlation bet. BMI and puberty onset?	Yes
What happens to the female pelvis during puberty?	Widens
**What is a Taner Rating of I?	pre-pubescent teste, penis childlike, no pubic hair
**What is a Taner rating of II?	Small increase in teste size, scrotum becomes redder, thinner, lgr.; no real change to penis; few sparse strands of pubic hair
**What is Taner rating of III	Testes' volume is 6-12 ml, penis lengthens; moderate amt. of hair
**What is a Taner rating of IV?	Testes' volume is 12-20 ml., Scrotum darkens, penis increases in length and circumference; hair is coarse, but does not extend to mid thigh
**What is a Taner rating of V?	Testes will hold >20 ml; penis and scrotum are adult size; hair is adult in quantity - extends to mid-thigh
At what stage do breasts develop small buds, areola widens?	II
At what stage do breasts begin having fatty tissue that extends beyond areola	III
At what stage are breast pre-pubertal and w/o glandular tissue?	I
At what stage are breast larger, with more elevation, but the areola and breast are still separate mounds?	Stage IV
At what stage are breast smooth and contoured?	Stage V
What is considered Early Psychosocial development?	Ages 11-14
What happens physically during early psychosocial development?	marked physical changes, easily embarrassed
What is occurring behaviorly in the Early psychosocial stage?	Fatigue, Irritability, Secretiveness, Sleep increase
What happens in Early psychosocial stage regarding Peers?	There are intense same sex relationships
At what point in psychosocial development do kids become less interested in family activities?	Early, 11-14
What age range is considered Middle Psychosocial development?	15-17
What physical concerns do kids in Middle stage of psychosocial development have?	concerned about being attractive
In what gender is change completed during the Middle Psychosocial development stage?	Girls, may cont. for boys
At what stage of psychosocial development are kids concrete thinkers?	In early stage
In what stage of psychosocial development are kids beginning to have more abstract thought and understanding relationships?	In the Middle psychosocial development stage
At what psychosocial development stage is group involvement the highest and there is more conformity with values	Middlepsychosocial development stage
At what stage of psychosocial development are parents consulted for advice?	Late stage
What is considered late stage psychosocial development?	ages 18-21
At what stage of psychosocial development are kids more secure in their sexuality?	Middle stage of psychosocial development
At what stage of psychosocial development does abstract thinking dominate, but still not consistent?	Late stage
At what stage of psychosocial development do kids feel omnipotent?	Middle stage of psychosocial development
At what stage of psychosocial development do kids refine their values, able to compromise and place priorities?	Late stage of psychosocial development
At what stage may kids begin to experiment?	Middle stage of psychosocial development
At what stage of psychosocial development do kids begin more risk taking?	Middle stage of psychosocial development
At what stage of psychosocial development are relationships more intimate w/ few closer friends?	Late stage of psychosocial development
What is the MC cause of morbidity and mortality among adolescents?	Unintentional and intentional injuries
What should be screened for at every adolescent visit?	Depression
What is the MC reason girls drop out of school?	Pregnancy
What are risk factors for early sexual activity RF?	I SSLLEEPP - Influence from peers/ media; Substance abuse, Sexual abuse, Low socioeconomic status, Lack of of social constraint, Emotional abuse, Early onset puberty, Poor academics, Poor parental supervision
What are factors that delay SA?	CRAPPP - Consistent discipline, Religious affiliation, Academic success, Parental support, Peer group support, Participation in Sports
What is a status offender?	An offense defined by age - truancy, curfew, runaway
What are RF for youth incarceration?	4 Lacks, 4 Lows and a Look: Low grades, Low lives, Low socioeconomic status, Low self esteem, Lack of at least 1 adult who cares, Lack of family unity, Lack of belonging, Look for sex/ phys abuse
What is the MC STD in adolescents?	HPV
What is the 2nd MC STD in youth?	Trichomonas
What is the recommended age for Gardasil?	12-24 y/o
How long is Gardasil effective?	5 yrs.
What males would Gardasil benefit?	Those have homosexual sex to avoid rectal cancer
What are the stages of abuse?	Experimental, Regular use, Daily preoccupation, Dependency
Are there behavior changes in the experimental phase of substance abuse?	No
What types of substances are the part of the experimental phase of substance abuse?	ETOH, Cigarettes, Marijuana, Inhalants
When is at what phase of substance abuse is the use unplanned and occasional?	Experimental phase of substance abuse
At what phase of substance abuse does use become regular/ planned?	Regular use phase of substance abuse
At what phase of substance abuse do subtle changes like drop in grades or dress happen?	At the regular use phase of substance abuse
What substances are used during the regular use phase of substance abuse?	Cigarettes, ETOH, Marijuana, Inhalants plus, pills, mushrooms, ecstasy
At what phase of substance abuse does the teen no longer use to get high, just use to feel normal?	Dependency
At what phase of substance abuse does the teen obsess w/ getting high, uses alone,?	Daily preoccupation phase
At what phase of substance abuse is the teen no longer able to maintain school or job?	Dependency phase
At what phase of substance abuse does the teen begin to use harder drugs?	Daily preoccupation stage
What are considered harder drugs?	PCP, Heroine, Cocaine, LSD
At what phase of substance abuse does teen use frequently and drift through maze of drugs?	Dependency stage
At what phase of substance abuse does the teen drop the pretense and openly a druggie, is defiant, and there is family turmoil	Daily preoccupation stage
**What is a sign of anorexia?	Something always wrong w/ the food, confused about food intake, family dynamics shaky
Why is compliance to OCPs difficult?	b/c of sporadic sexual activity
How can you discuss sex w/ a teen pt.	Ask them if they are sexually active and if they state no, ask them when they think an appropriate age to start having sex is and discuss ways to keep it from happening sooner than the stated age - bikini no touch zone
What if a teen decided to use the patch as birth control?	discuss not wearing a thong or going commando b/c patch will pull off, ask them to set cell phone reminders
What if a teen says they want to use a barrier method for birth control?	Explain that that is only an adjunctive method and req's communication, planning, and cooperation
What factors should be considered when discussing birth control w/ teens?	FANI MAE - Frequency of sex, Acceptance, Number of partners, Issues of safety, Motivation, Access, Effectiveness
What ages does CDC recommend testing for HIV?	13-64
How often should STDs be screened?	Annually, regardless of if they admit to being active or not
When should pregnancy tests be considered?	Starting on BC, missed periods, irreg. bleeding, abdominal pain, or vomiting
Should BC be withheld if pt. refuses pelvic exam?	No
What is considered a legal adult?	If 18 or older OR married, OR emancipated by the court at 16-17
Why do you establish a code with your pt.?	To discuss medical information over the phone
When should police be notified of sexual activity?	If your pt. is under 14 having sex and has never been married; if 14-16 and partner older by more than 3 yrs; any sexual contact with same sex partner
What should you tell pts about confidentiality?	Assure it, but state that there may be legal need to report
What can cause jaundice in 2nd week of life?	Breastfeeding
What are risks for physiologic jaundice?	Rh/ABO incompatibility, pre-term, breastfeeding
What are criteria to Dx Rheumatic Fever?	Named after the doc that set criteria: JONES (where the O should be a heart) - Joints, Heart, Nodules, Erythema Marginatum, Syndenham Chorea
**Kid sent home from school, 1 eye watering and red, and a pre-auricular node, what is the etiology?	Viral
**Typical profile of Slipped Capital Femoral Epiphysis?	Obese boy
**Initial treatment of Developmental Dysplasia of Hip?	Pavlik Harness
**Girl comes in with left knee pain, right ankle pain, blurred vision, blindness	Pauci-Articular JRA
**Most common form of Scoliosis?	Idiopathic
**If a 9 month old comes in and cannot sit up by themselves, should you be worried?	Yes
**Treatment for Kawasaki?	ASA and Immunoglobulins
**Radiographic evidence of bronchiolitis?	Hyperinflation
**Kid comes in with foul smelling discharge from nose, likely Dx?	Foreign body
**Treatment for Croup?	Corticosteroid
**Teen comes in with painful lesions on buccal and labial mucosa, likely DX?	Apthous Ulcers
**Initial treatment when child has 8.2 iron level?	Supplement with iron?
**CP of Hemolytic Uremic Syndrome	Usually after bout of gastroenteritis
**girl comes in two weeks post sore throat complaining of joint pain and you find a new murmur, likely DX?	Rheumatic fever
**Sand-paper like rash, positive strep, likely Dx?	Scarlet fever
**Several bouts of pneumonia and fat globules in stool, likely DX?	CF
A pt. is on a rescue inhaler, but now has **Sx's everyday and most nights too, what med do you add?	ICS
**Pt. comes in with inspiratory and expiratory wheezing, has them often, what is the likely Dx?	RAD
**What is a contra-indication for MMR vaccine?	HIV
**Tx for Sickle Cell Anemia if several bouts of vasculitis?	Hydroxurea
**What drug is exclusively for absence seizures	Ethosuxamide
What drug do you use on newborn w/ conjunctivitis?	topical Sulfanamide?
CP of adolescent depression and TX?	Bad grades, altered sleep patterns, weight loss; Prozac is first line TX

Created by: doggiekylesmom

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