Fmp - Week 3 & 4

Front 1

All vaccines are given IM except for which 2?

Back 1

MMR and Varicella are given SQ

Front 2

What are conjugated vaccines made of?

What is it effective against?

Back 2

Polysacharide from wall of a cell that's conjugated to a protein that's easily recognized by your body. Causes the production of memory B cells & Ab's that last a long time.
** Effective against encapsulated organisms

Front 3

What are the 3 conjugate vaccines?

Back 3

1. Hib
2. Pneumococcus (prevnar)
3. Meniningococcus (Menjugate)

Front 4

What vaccines are given at the following ages:
- 2 months
- 4 months
- 6 months

Back 4

- 2 months: DPTP - Hib & Pneumococcal Conjugate
- 4 months: DPTP - Hib & Pneumococcal Conjugate
- 6 months: DPTP - Hib & Pneumococcal Conjugate

Front 5

What vaccines are given at the following ages:
- 12 months
- 15 months

Back 5

12 months: Meningococcal C & MMR

15 months: Varicella & Pneumococcal Conjugate

Front 6

What vaccines are given at the following ages:
- 18 months
- 4 years

Back 6

18 Months: DPTP - Hib & MMR

4 years: DPTP - Hib

Front 7

When is the DPTP - Hib vaccine given?

Back 7

2mo, 4mo, 6mo, 18mo, 4 years

Front 8

When is the pneumococcal vaccine given?

When is the MMR vaccine given? How about meningococcal C?

When is the Varicella vaccine given?

Back 8

Pneumo: 2mo, 4mo, 6mo, 15 mo

MMR: 12mo, 18mo
Mening: 12mo

Varicella: 15mo

Front 9

What is the definition of Colic?

Back 9

Crying for at least 3hrs/day, 3days/week, 3weeks in a row. Often cries more often.

Front 10

What are the contraindications of Bfeeding? (5)

Back 10

- galactosemia in baby
- active, untreated TB
- HIV
- Medications
- illicit drugs

Front 11

Describe the follwoing rash:
Cafe-au-Lait spots

Back 11

macules, usually benign but can signal neurofibromatosis

Front 12

Describe the follwoing rash:
Mongolian Spots
(color, location, ethinicity)

Back 12

- blue-black
- lumbo saccral area
- orriental/black

Front 13

Describe the follwoing rash:
Urticaria (Hives)

( what causes transient vs. persistent)

Back 13

Wheal (raised white centre), Flare (flat red outside).

Transient = infection, drugs & foods (foods usually have sudden onset & resolution)
Persistent = cold temperatures or exercise induced

Front 14

Describe the follwoing rash:
Milia

Back 14

small <2mm, white pustules/papules, usually on face/scalp. Spontaneously resolve over several months

Front 15

What causes "hand-foot-mouth" disease?
What type of rash do you get?

Back 15

Coxsackie virus
Papular vesicular rash
+++ contagious
* the hand & foot distribution distinguishes it from varicella!

Front 16

Describe the follwoing rash:
Atopic Dermatitis
- location in infants vs. children
- type of rash
- 3 principles of Tx

Back 16

The itch that rashes
- infants: cheeks, extensor surfaces
- children: flexures
- rash = red, dry, itchy & scaly

Tx:
1. Moisturize - with ointment/creams
2. Control the itch - oral antihistamine
3. control the inflammation (HCTZ cream)

Front 17

How can you distinguish diaper rash from a candidal infection?

Back 17

Diaper rashes spares the inner folds whereas candida (beefy red) involves the creases and has satellitle lesions.

Front 18

What produces scaly, papular, rashes with a clear centre?

Back 18

Fungal dermatophytes = Tinea Corporis

Front 19

Describe the follwoing rash:
Hemangiomas
- Xtics (when does it appear?)
- Tx?

Back 19

Hemangiomas
- not usually visible at birth,--> rapid growth --> slow, spontaneous involution
- Tx: spontaneous involution in most, can laser if in a bad area

Front 20

What is the name of the "slapped cheek" rash?
- cause?
- why is it important?

Back 20

Erythema Infectiosum
- Parvovirus B19 infection
- important b/c can cause aplastic anemia (but no fever and not unwell!)

Front 21

What causes scarlet fever?
- 5 Xtics?
- Dx how?
- Tx with what?

Back 21

GAS
- sand-paper rash
- peeling fingertips
- strawberry tongue
- fever
- pharyngitis
Dx = swab
Tx = penicillin

Front 22

People with what type of attachment tend to experience victimization?

Who victimizes them?

Back 22

People with ambivalent/resistant tend to get victimized b/c they feel they aren't worthy of love & affection and they want to please but feel they can't ever.
Avoidant-type of people tend to be the victimizers

Front 23

75% of kids with what type of attachment develop the most severe forms of psychopathology?

Back 23

75% of kids with disorganized attachment develop the most severe forms of psychopathology?

Front 24

What are the 3 benefits to you responding promptly to infants early in life?

Back 24

1. Baby will cry less
2. Baby will be more independent
3. Baby will respond to you

Front 25

Cortisol levels normally peak around 10-12am then declines throughout the day to allow for sleep at night. What happens to kids with DV exposure?

Back 25

DV exposure raises the levels of cortisol such that it peaks in the afternoon/evening and disrupts their sleep. As a result these kids are less able to function at school during the day.

Front 26

Too much cortisol for too long will do what to the hippocampus?

What is the function of this part of the brain?

Back 26

- shrinkage (in adults who experience PTSD)

- learning & explicit memories

Front 27

What is the function of anterior cingulate gyrus of the brain?

What happens when/if this area is damaged?

Back 27

selectively paying attention to one important thing while ignoring other things

- damage = trouble focusing attention and inhibiting inappropriate actions

Front 28

What is the function of amygdala of the brain?

What happens when/if this area is damaged?

Back 28

Amygdala = processing of negative events, & triggering elevations of adrenaline & cortisol in response to negative emotional stimuli

Damage = more sensitive to negative emotions & more likely to produce hormonal stress reactions when threatened

Front 29

What is the function of pre-frontal cortex of the brain?

What happens when/if this area is damaged?

Back 29

Pre-frontal cortex: sensitive to information about social environment & social partners

Damage = makes it especially difficult to act appropriately in social situations

Front 30

What are two effects (on the brain) of PTSD?

Corpus Callosum area, intra-cranial volume & IQ are negatively correlated with what?

Intra-cranial volume is correlated with what?

Back 30

1 Lower intracranial volumes
2. Smaller volumes of corpus callosum & hippocampus

CC area, IC volume & IQ are negatively correlated with the duration of maltreatment experienced by a child

IC volume is also correlated with teh age of onset of maltreatment

Front 31

How (specifically!) does fever change your fluid requirements?

Back 31

For every degree above normal, fluid requirements increase by 12%

Front 32

Describe how a kid would look at each of the following levels of dehydration:
- 5%
- 10%
- 15%

Back 32

5%: less tears, dry mouth
10%: decreased urine, sunken eyes & fontanelle, apathetic
15%: shock & abnormal vital signs

Front 33

What is the Abx treatment for bacterial sinusitis (3 lines)?

Back 33

1. Amoxicillin (40-50mg/kg)
2. Amoxicillin at double dose or Amoxicillin + Clavulanate acid
3. Cephalosporin or Macrolides

Front 34

What are 2 ways of preventing neonatal HSV?

What is the Tx for neonatal HSV?

Back 34

1. C/S if mother in the presence of HSV lesions
2. Oral acyclovir for women with recurrent genital HSV

Tx: IV acyclovir for 2-3 wks (2wks if disease restricted to skin, eye & mouth)
** highly effective if started early!

Front 35

What's involved in a full septic workup?
5 things

Back 35

1. CBC & blood culture
2. Urinalysis & culture
3. LP
4. CXR (if resp signs/symptoms)
5. Stool O&P / culture (if GI S/S)

Front 36

In a febrile neonate with a negative LP, was is the indicated empiric therapy?

What if the LP is positive?

Back 36

Ampicillin & gentamicin if no evidence of meningitis

Ampicillin & cefotaxime if there's evidence of meningitis

Front 37

What would you do for a high risk neonate with a temp >= 39.0? (3 things)

Back 37

1. Urinanalysis & culture
2. If no Prevnar vaccine then consider CBC & Bculture)
3. CXR if resp symptoms

(also give acet & return if fever > 48hrs)

Front 38

What is your approach to the toxic appearing infant in the following ages:
0-28 days
28-90
3-36 months

Back 38

0-28 days = FSWU + empiric therapy
28-90 days = clinical & lab screening + Asx risk --> manage according to risk
3-36 months = vast majority have a viral illness therefore clinical f/u + - selected tests.

Front 39

In cases of meningitis, public health recommends prophylactic Abx for close contacts of which 2 causes of meningitis?

Back 39

1. H. influ B
2. N. meningitidis

** not for S. pneumo

Front 40

Name 5 pathological changes seen in asthma?

Back 40

1. mucous plugs
2. hypertrophy of the smooth muscle
3. intersitial edema
4. vasodilation
5. submucous gland Hplasia

Front 41

What happens to pCO2 and pH when asthma-induced hypoxemia causes HYPERventilation? What happens to these values when the child tires and HYPOventilates?

Back 41

Hvent = ↓ pCO2 & ↑pH

HoVent = ↑pCO2 & ↓pH

Front 42

What types of things should you ask on Hx when seeing a kid with an asthma attack?
(5 things)

Back 42

1. Severity of current symptoms & at baseline (activity limitations)?
2. Tiggers? Exposures?
3. Hospital & ICU admissions?
4. Medication Hx (including compliance),
5. Any complicating medical Hx?

Front 43

What are 5 signs of severe/late asthma?

Back 43

1. Dyspnea such that can't talk/feed
2. Cyanosis
3. Silent chest (no wheeze) or feeble resp effort
4. Fatigue
5. Evidence of pneumothorax (will cause unilateral silent chest)

** also look for SQ emphysema (most common in the neck!)

Front 44

What are 4 acute causes of chronic coughing?

What would insp & exp xrays show you?

Back 44

1. Infection
2. Pulmonary Edema
3. Pulmonary hemorrhage (kids won't cough up blood --> they'll swallow it back down)
4

Front 45

Sweat chloride testing:
positive = ?
grey zone = ?
negative = ?

Why does the newborn CF screening test look at trypsinogen?

Back 45

positive = >= 60mmol/L
grey zone = 30-59mmol/L
negative = < 30 mmol/L

Look for trypsinogen because in utero pancrease gets fibrotic & tryp will leak out into the blood!

Front 46

At what ages to HT and Wt double (respectively)?

What are the average Ht & Wt's at birth? What about head circumference? By how much should HC increase in the first year?

Back 46

Ht doubles after 4 years
Wt doubles after 5months!

Ht = 50cm
Wt = 3 - 3.5kg
HC = 35cm, increases by 12cm in 1st year?

Front 47

What is the acceptable growth velocity amongst children?

Back 47

6cm/year. Anything less than 5cm/yr is concerning!

Front 48

When evaluating a kid with short stature, what are 4 questions you should ask yourself?

Back 48

1. Was there IUGR?
2. Is the child proportionate?
3. Is the growth velocity normal?
4. Is there a discrepency between bone age & chronological age?

Front 49

Why would a VSD not be heard at birth but heard later?

Back 49

May not be heard at birth b/c not very much flow across the deftct. But as R sided pressures fall the gradient for flow will increase and with more flow the murmur will become audible. Thus they tend to present in the 1st few months.

Front 50

Describe an innocent and pathologic murmur in terms of:
- sound
- timing
- grade

Back 50

Sound:
Innocent = musical
Patho = harsh

Timing
Innocent = systolic ejection
Patho = Sys or diastolic, ejection/pan, etc

Grade
innocent = low
patho = high

Front 51

For the JIA subtype :Oligoarthritis, which joint tends to be most affected?
- gender? age?
- RF, ANA + or --?
- complications

Back 51

- tends to affect larger joints, most commonly the knee
- F>M, <5yrs
- RF --v, ANA + ve
- complications: knee flexion contracture, quadriceps atrophy, length discrepency

Front 52

For the JIA subtype :Polyarthritis, which joint tends to be most affected? (effect on these joints)
- gender? age?
- RF, ANA + or --?
- complications (2)

Back 52

- affects small & large joints (causes under growth in small & excessive growth in large!) E.g cervical spine & TMJ
- YOung F > M
- ANA + in 50%, RF usually --ve
- Uveitis in 10%; growth disturbances

Front 53

In what type of JIA is uveitis most common? What is it associated with?

Back 53

Most common in oligoarticular
Associated with +ve ANA

**Asymptomatic therefore requires screening eye exam! **
--> if missed can get ++ visual loss!