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135 Cards in this Set
- Front
- Back
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abdominal or flank mass in children should be F/U and referred to r/o ______?
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Wilm's tumor (nephroblastoma)
common in females, young children 90% survival rate if caught early |
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UA w/ culture
-alkaline pH + postiive nitrate + leukocytes = ? -hematuria + pyuria + no bacteria = ? -protein= ? -RBC casts= ? -Crystals= ? |
-alkaline pH + postiive nitrate + leukocytes = UTI
-hematuria + pyuria + no bacteria = suspect STI or viral infection -protein= glomerulonephritis -RBC casts= glomerulonephritis -Crystals= renal calculi |
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what warrants a referral to urology?
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-urologic trauma
-recurrent UTIs- boys 1st UTI; girls 2nd UTI -suspected glomerulonephritis -thrombocytopenia -suspected renal calculi -family hx or risk factors for malignancy -persistent hematuria with hypertension, proteinuria |
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4 year old Milestones
gross motor fine motor cognitive/linguistic/communication social-emotional |
GROSS MOTOR
-balance on each foot 2 sec -hop FINE MOTOR -tower of 8 cubes -draw a person w/ 3 parts LANGUAGE -Speech all understandable -Name 4 colors -Define 5 words SOCIAL-EMOTIONAL -Copy a circle -Copy a cross (+) |
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Middle Childhood--Social and Emotional Development
Self? |
SELF ESTEEM
-experiences of success -reasonable risk-taking behavior -resilience and ability to handle failure -supportive family and peer relationships SELF-IMAGE -body image, celebrating different body images -prepubertal changes; initiating discussion about sexuality and reproduction; prepubertal changes related to physical care issues |
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Middle Childhood--Social and Emotional Development
Family? |
WHAT MATTERS AT HOME:
-expectation and limit setting -family times together -communication -family responsibilities -family transitions -sibling relationships -caregiver relationships |
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Middle Childhood--Social and Emotional Development
Friends? |
FRIENDSHIPS
-making friends, friendships with peers with and without special health care needs -family support of friendships, family support to have typical friendship activities, as appropriate |
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Middle Childhood--Social and Emotional Development
School? |
SCHOOL
-expectation for school performance, school performance/ defined in the Individualized Education Program -homework -child-teacher conflicts, building relationships with teachers -parent-teacher communication -ability of schools to address the needs of children from diverse backgrounds -awareness of aggression, bullying, and victimization -absenteeism |
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Social and Emotional Development in Middle Childhood
Community? |
COMMUNITY STRENGTHS
-community organizations -religious groups -cultural groups HIGH RISK BEHAVIORS AND ENVIRONMENTS -substance use -unsafe friendships -unsafe community environments -particular awareness of risk-taking behaviors and unsafe environments, because children may be easily victimized |
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Classic definition of RAP (recurrent abdominal pain)
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>/=3 months
>/=3 episodes interferes with normal activity no identifiable organic etiology |
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Diagnostic Criteria for IBS (Irritable Bowel Syndrome)
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Includes ALL of the following:
-abd discomfort or pain associated with 2 or more of the following sx 25% of the time *improved w/defecation *onset associated with a change in frequency of stool *onset associated with a change in form (appearance) of stool -no evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject's sx -criteria fulfilled at least 1x/wk x2 months -sx: abn stool frequency, abn stool form, abn stool passage, passage of mucus, and bloating and distention |
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RED F.L.A.G.S of RAP (recurrent abdominal pain)
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F- fever, family hx of IBD
L- loss of weight A- abnormal PE (anal anomalies) G- growth retardation, GI blood loss S- significant vomiting or diarrhea |
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T or F
Goal of therapy for FAP is to cure the pain. |
False
Goal of therapy: resume normal functioning, NOT cure the pain 30-40% resolve |
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Newborn Screening Tests
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ALL states-- PKU, hypthyroidism, classic galactosemia, sickle cell disease
Most states- congenital adrenal hyperplasia, homocysteinuria, maple syrup urine disease, biotinidase deficiency Some states- tyrosinemia, CF, toxoplasmosis, and HIV |
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CHO Metabolism Glycogen Storage diseases
Hepatic forms? Myopathic forms? Evaluation? |
-Hepatic forms cause growth failure, hepatomegaly, severe fasting hypoglycemia
-Myopathic forms affect skeletal muscle-- weakness, rhabdomyolysis, Evaluate- glucose, lactate, triglycerides, cholesterol, uric acid, transaminases, CK Functional test- response to fasting and glucose Ischemic stress test |
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Galactosemia
presentation? treatment? |
-deficiency or lack of galactose-1-phosphate uridyltransferase-- leading to an accumulation of G1P in liver and renal tubules-- causing hepatic and renal disease
-Presentation in nenonates: vomiting, jaundice, hepatomegaly, rapid onset of liver insufficiency after milk ingestion, progressive hepatic cirrhosis -Txt: Galactose free diet, supplement with Ca -monitor G1P blood levels, -if no treatment, death within 1 mo |
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CHO Metabolism Hereditary
Fructose Intolerance |
-deficiency of fructose-1-phosphate aldolase
-causes hypoglycemia, tissue accumulation of F1P following fructose ingestion -Failure to thrive, vomiting, jaundice, hepatomegaly, proteinuria, aminoaciduria, -if untreated, death from liver failure, -Evaluate: IV fructose load test -Txt: fructose free diet, give vitamin supplementation -monitor transferrin glycoform |
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1st indicator of pubertal delay (lateness)
Girls-- no breast development by _____, or menarche by ____yrs after breast development (or by age 16) Boys- no testicular enlargement by ___yrs |
Girls-- no breast development by 13 yo, or menarche by 3 yrs after breast development (or by age 16)
Boys- no testicular enlargement by 14 yrs |
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sequence of events in puberty for boys
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1. growth of testicles
2. pubic hair appears 3. growth of penis, scrotum 4. axillary hair 5. first ejaculations 6. growth spurt 7. facial hair 8. adult height |
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sequence of events in puberty for girls
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1. breast bud appears
2. pubic hair appears 3. growth spurt 4. axillary hair 5. pubic hair matures 6. breasts mature 7. menarche 8. adult height |
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2nd indicator of pubertal delay
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disconcordance
-in most children, puberty proceeds as a predictable series of changes in specific order -in children with ordinary constitutional delay, all aspects of physical maturation typically remain concordant but a few years later than average. -If some aspects of physical development are delayed, and others are not, it is likely that something is wrong. |
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3rd indicator of pubertal delay: Indications of specific disorders
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malnutrition or anorexia nervosa-- delay puberty
poor growth-- hypothyroidism or turner syndrome reduced sense of smell (hyposmia)-- kallmann syndrome |
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define precocious puberty
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- early puberty
Females -whites 7 yo -blacks 6 yo Males -8 yo |
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premature thelarche
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isolated breast development before age 6.
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Calculating midparental height for girls and boys.
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girls
mother's height + (father's height - 5 inches)/2 boys father's height + (mother's height + 5 inches)/2 |
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abnormal growth findings suggesting the need for referral
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1. height-- growth < 3%ile or >95%ile
2. growth velocity-- decreased or accelerated growth velocity for age 3. genetic potential--projected height varies from midparental height by more than 5cm (2in) 4. Multiple syndromic or dysmorphic features: abnormal facies, midline defects, body disproportions 5. bone age: advanced or delayed by more than 2 SD |
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criteria for evaluation of short stature
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-height below 2 SD for age (or 3rd percentile)
-height below genetic potential (2 SD below midparental height) -abnormal growth velocity after age 18 months (downward crossing of major height percentiles) |
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Murmurs always to be referred
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-diastolic murmur (except venous hum)
-associated with thrill (grade IV and above) -regurgitant murmur -abnormal heart sounds (S4) -abnormal pulses -symptomatic -abnormal chest xray -abnormal electrocardiogram -when you as the provider feel uncomfortable |
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Derm
"slapped cheeks," reticulated erythema caused by Human Parvovirus B19 |
Erythema infectiosum (5th disease)
txt: observation; no longer contagious after rash appears |
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high fever x3 days, but child not too sick.. Then rash breaks out-- pink macules, fades away in 1-2 days
caused by Herpes virus 6 |
roseola infantum
txt: observation |
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Very slightly itchy eruption x 10 days
patch confused with tinea corporis caused by herpes virus 7 |
pityriasis rosea
Txt: observation, antipruritics prn, ?erythromycin, oral corticosteroids |
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3 yo w/ high fever for 6 days, ill appearing, also has perianal eruption
has 5 of 6 -fever of unknown origin >5 days -conjunctival injection -changes in lips or oral mucosa -cervical lymphadenoapthy -polymorphous exanthem -changes of peripheral extremities |
Kawasaki's disease
-associated with coronary aneurysms Txt: Aspirin, IVIG |
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Verrucae
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Warts
caused by human pappilloma virus txt: salicyclic acid plasters, duofilm, cantharone, liquid nitrogen |
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viral skin infection that causes raised pearl-like papules or nodules on skin.. caused by poxvirus, umbilicated papules
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Molluscum contagiosum
Txt: cantharone, imiquimod (aldara), duofilm/scotch tape, liquid nitrogen, curretting, or observation |
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Newborn rash
pusules filled with eosinophils resolves in few days |
erythema toxicum neonatorum
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newborn with scattered pustules and small tan spots
central pigmentation within resolving pustules |
transient neonatal pustular melanosis
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"white bumps" on newborn
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milia
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child born with large "mole"
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large congenital nevus
-risk of malignant melanoma--need biopsy -observe for malignant change |
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dark area on newborn, since birth getting darker
very common in asians, african americans |
mongolian spot or dermal melanocytosis
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yellow/pink bumpy area on scalp hasn't had hair since birth
becomes verrucous |
nevus sebaceus
txt: excision when child can tolerate local anesthesia due to frequent malignant change (usually BCC) |
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newborn born with a patch of skin missing, usually on the scalp (70% of individuals), but it may also occur on the trunk, arms, or legs. May be osseous as well as cutaneous defects
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Aplasia cutis congenita
need skull imaging to r/o deeper defects (meninges) |
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rash- ichy, macules and papules present
cough, fever, coryza, conjunctivitis, koplik's spots |
Measles
txt: supportive care, vitamin A |
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follows a strep pharyngitis
linear petechiae- pastia's lines, rash will appear like sandpaper--"goosebumps on a sunburn" |
Scarlet Fever
txt: oral abx |
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Early symptoms are likely to be fever often followed by a sore throat. Loss of appetite and general malaise may also occur. Between one and two days after the onset of fever, painful sores (lesions) may appear in the mouth and/or throat. A rash may become evident on the hands, feet, mouth, tongue, inside of the cheeks, and occasionally the buttocks (but generally, the rash on the buttocks will be caused by the diarrhea.) Disease is caused by coxsackie virus A16 most commonly
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Hand, Foot, Mouth Disease
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systemic infection caused by bacteria Neisseria meningitidus---> sx: fever and petechiae
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Meningococcemia
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Early Adolescence (11-14yo)
PHYSIOLOGICAL PSYCHOSOCIAL SOCIAL POTENTIAL PROBLEMS |
Early Adolescence (11-14yo)
PHYSIOLOGICAL -onset of puberty, growth spurt and menarche (females) PSYCHOSOCIAL -concrete thought, preoccupation with rapid body changes, parental control strong SOCIAL -same-sex peers, involvement in extracurricular activities POTENTIAL PROBLEMS -delayed puberty, acne, school problems |
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Middle Adolescence (15-17 yo)
PHYSIOLOGICAL PSYCHOSOCIAL SOCIAL POTENTIAL PROBLEMS |
Middle Adolescence (15-17 yo)
PHYSIOLOGICAL -ovulation (females), growth spurt (males) PSYCHOSOCIAL -competence in abstract/future thought, sense of invincibility or narcissim, sexual identity SOCIAL -emotional emancipation, increased power of peer group, conflicts over parental control, interest in sex POTENTIAL PROBLEMS -experimentation with health risk behaviors (drug use, ETOH, smoking, sex), unintended pregnancy, acne, conflicts with parents, eating d.o |
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Late Adolescence (18-21 yo)
PHYSIOLOGICAL PSYCHOSOCIAL SOCIAL POTENTIAL PROBLEMS |
Late Adolescence (18-21 yo)
PHYSIOLOGICAL -growth complete PSYCHOSOCIAL -future orientation, self-identity, capacity for empathy, intimacy and reciprocity in interpersonal relationships SOCIAL -individual over peer relationships, transition out of home, prepare for further education, career, marriage, parenting POTENTIAL PROBLEMS -eating d.o, unintended pregnancy, smokng, ETOH, drug dependence |
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management of UTI
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Bactrim BID x10 days
Cefixime BID x10 d if sulfa allergy Phenazopyridime (pyridium) for dysuria in children >6 yo follow up culture in 48-72 hours to confirm treatment working; follow up UA 3 to 4 days post completion of abx |
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when is hypospadias referred?
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referral to Urology by 18 mo and preferably prior to toilet training
*circumcision is contraindicated prior to surgery b/c the foreskin will be used as a skin graft for surgery |
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In Cyrptorchidism, if testes do not descend by ____of age they typically will not spontaneously descend.
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3 months
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Failure to diagnose cryptorchidism can result in_____.
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decrease in semen production and infertility, increased risk of testicular cancer, and increased risk of testicular torsion and hernia
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Hydrocele
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-collection of peritoneal fluid trapped in scrotal sac, causing painless, scrotal swelling
-2 types: communicating and noncommunication -communicating-- flat scrotum in the morning with a gradual increase of fluid during the day, requires surgery, potential for hernias -noncommunicating--most common, may not need surgery, typically fluid absorbs and hydrocele resolves, no hernia |
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Variocele
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-abnormal dilations in the testicular veins due to valvular incompetence of the spermatic vein.
-most commonly unilateral on left side -varioceles on right side may be d/t obstruction from tumor -associated with infertility |
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Right sided varioceles
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new onset consult specialist regarding venography and doppler US to r/o venous obstruction or renal carcinoma
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what findings and symptoms of variocele to report to surgeon
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-right sided variocele
-large variocele that is increasing in size or not relieved with sitting or laying down -pain -testicular atrophy--2 or more SD in testicular size -greater than 2ml difference in testicular volume per US -deteriorating semen volumes |
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phimosis
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a condition where, in men, the male foreskin cannot be fully retracted from the head of the penis.
management: includes gentle stretching of foreskin while cleansing |
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paraphimosis
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occurs when the foreskin of an uncircumcised male cannot be pulled back over the head of the penis.
management: ice to affected area to reduce swelling so foreskin can be reduced, do not force, may need surgery |
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testicular torsion
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Medical emergency!
twisting of spermatic cord which results in compromised testicular blood flow, testis is not fixed in scrotal sac so it will rotate/twist, testis rotates on spermatic cord occluding blood supply. |
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testicular torsion requires surgical treatment within____ hours
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4-8 hours
(100% testicular survival rate if intervention <3 hours) prevent ischemic injury and necrosis of the testis |
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s/s of testicular torsion
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pt will present with sudden onset of extreme scrotal pain.. Left side more common
-lower abdominal pain that mimic appendicitis -nausea/vomiting -appears ill -anxious and unwilling to move |
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Cremasteric reflex in testicular torsion
Prehn's sign |
Cremasteric reflex--testicular retraction when the upper, medial thigh is stroked
no reflex= testicular torsion Reflex is present in epididymitis (reflex will help differentiate torsion vs. epididymitis) b/c onset of sx are similar Prehn's sign (positive sign=pain relief w/ elevation)-- elevation will increase pain in torsion, but elevation will decrease pain in epidydmitis |
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Epididymitis
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inflammation of epididymitis
50% of pts present with fever -scrotal edema -epididymis hard, indurated, enlarged, tender -Prehn's sign Positive (pain relief with elevation) -Urethral d/c may be present -rectal exam-- positive prostate tenderness |
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when to refer to urology in pts with epidymitis?
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-no hx of sexual intercourse, single side testicle, response to treatment is not prompt
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Management of epididymitis
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bed rest, scrotal support, elevation, ice packs, nsaids for pain
abx -ceftriaxone 250mg IM -doxycycline 100mg BID x10 days |
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complications of epididymitis
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infertility, abscess, testicular infarction
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Red Flags of tumors
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-persistent pain
-constitutional sx: fever, night sweats, night pain, malaise, poor appetite, wt loss -persistent limp -physical exam findings: masses, inflammation, lymphadenopathy, neuropathy, myopathy |
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-most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates of the calcaneus in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 14 years of age.
-common in soccer, football, track |
Sever's disease
calcaneal apophysitis |
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idiopathic osteonecrosis of femoral head in children b/w 4-8 yo, usually unilateral
-limping for 3-6 wks -activity worsens limp -pain in groin or proximal thigh -restricted abduction -xray shows increased density of femoral head or crescent sign |
Legg Calve Perthes disease
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management of Legg Calve Perthes disease
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-casting for 1 1/2 yrs
-if not better with casting, surgery--"containment"-- keep the ball of the femur inside the socket |
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management of scoliosis 10-20 degree
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observe
xray every 6 months |
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management of scoliosis 25-45 degrees
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Brace-- it does not "correct" the curve but prevents further progression of the curve
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management of scoliosis more than 45 degrees in skeletally immature pt or more than 55 degrees in mature adult
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surgery-- put rods in
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risser grade
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each grade from 1-4 corresponds with a 25% increment of iliac crest ossification. A low grade indicates that the skeleton still has considerable growth. A Risser grade 5 corresponds to skeletal maturity. The lower the Risser grade at the time of curve detection, the greater the risk of progression. The Risser Scale differs between genders
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spondylolysis
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fracture of pars interarticularis
-picked up on bone scan |
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spondylolisthesis
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most common cause of Low back pain in adolescent athletes
-occurs when a superior vertebra slips forward on the adjacent inferior vertebra -more common in L5 area, less in L4 -rapid growth can encourage slippage |
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What grade of spondylolisthesis needs surgery-- fusion?
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>50% (Grade 2)
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common cause of knee pain in skeletally immature athlete
-tenderness below knee (tibial tuberosity) - |
Osgood-Shclatter
anterior tibial tubercle apophyseal traction |
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Salter Harris Classification of Fractures...only for peds patients if growth plates have not closed
-girls close 1 year after onset of menses |
I- separation through physis
II- metaphyseal spike III-separation through physis and vertically through epiphysis IV-fracture through metaphysis, through physis, and vertically through epiphysis |
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Treatment of Functional Abdominal Pain
dietary changes? |
high fiber diet (5gm + age)
low fat diet small frequent meals avoid gum, cabbage, legumes, carbonation, or excessive fructose and sorbitol |
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Indications for GI referrals
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GI bleeding
dysphagia aspiration pneumonia failure to thrive failed empiric therapy daily regurgitation past 1 yr |
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Feeding interventions for GER without complications
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in the thriving infant without any complications, treatment is supportive
Feeding interventions -thicken feedings with rice cereal -ensure proper burping techniques -supine positioning still recommended -small frequent feedings |
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Pharmacologic therapy of GER
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antacids
H2 receptor antagonists PPIs Prokinetics |
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Indications for antireflux surgery
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-failure of optimal medical therapy
-life threatening manifestations of reflux -some neurologically impaired children with GER who require a feeding gastrostomy |
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the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter), which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.
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Nissen Fundoplication surgery
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clinical manifestations of intestinal obstruction
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-poor feeding, irritability, abdominal distention
-abd pain -vomiting (bilious, may be feculent) -constipation, failure to pass gas -peritonitis -partial obstructions |
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top 4 causes of intestinal obstruction
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pyloric stenosis 25%
intussusception 18% intestinal atresia 15% incarcerated hernia 11% |
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hallmark signs of pyloric stenosis
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hallmarks: projectile emesis and failure to thrive
-assoc with esophageal and duodenal atresias, anorectal anomalies, hiatal hernia, and GER -hypochloremic metabolic alkalosis-- must correct with NaCl prior to surgery -Abdominal pain -Belching -Constant hunger -Dehydration (gets worse with the severity of the vomiting) -Wave-like motion of the abdomen shortly after feeding and just before vomiting occur |
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diagnosis of pyloric stenosis
treatment |
US
pyloromyotomy--split the overdevelopmed muscles |
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features of ileus
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-absent colicky pain
-dull, diffuse pain from distention -vomiting frequent, not profuse (bilious, NEVER feculent) -obstipation and constipation -small volume stools from peritonitis |
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Intussusception
s/s |
-triad of sx: crampy abdominal pain, vomiting and "currant jelly" stools
-sequence of sx: colic followed by irritability, anorexia, and vomiting and lastly, bloody diarrhea -often follows an acute viral infection |
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diagnosis of intussusception
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US
Contrast air or radiopague enema under fluoro for diagnostic and therapeutic intervention --90% success, recurrence 10% |
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Some pts with celiac disease have an increased risk for ____
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malignant neoplasm (small bowel lymphoma)
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a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.
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When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi.This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.
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Presentation of Celiac disease in infancy and older children
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-typically manifest during infancy-- malabsorption, diarrhea, vomiting, abdominal distention, failure to thrive
-older children-- delayed puberty, short stature, iron deficiency, anemia, osteoporosis |
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diagnosis of celiac disease
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-serological studies
Tissue tranglutaminase antibodies Antiendomysial antibodies HLA typing *Gold standard-- intestinal biopsy by endoscopy-- flattened villi and notching of kerkring folds; histology--villous blunting, increased intraepithelial lymphocytes |
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most common food allergy
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milk
other include soy, eggs, peanuts, tree nuts, and fish presents with chronic diarrhea, failure to thrive, abdominal distention, eczema and peri-anal rash |
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contraindications to enteral nutrition
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peritonitis
obstruction severe ileus refractory vomiting enteric fistulae |
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in childhood, normal growth is ____/yr
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5-6.5cm/yr
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1st indicator of pubertal delay: lateness
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-delay of 2-3 yrs or more warrants evaluation
-delay of 2 SD is standard -girls: no breast development by 13 yrs, or no menarche by 3 yrs after breast development (or by age 16) -boys: no testicular enlargement by 14 yrs |
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2nd indicator of pubertal delay: disconcordance
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not following the predictable sequence of events in puberty
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sequence of events in puberty for boys
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1. growth of testicles
2. pubic hair appears 3. growth of penis, scrotum 4. axillary hair 5. first ejaculations 6. growth spurt 7. facial hair 8. adult height |
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sequence of events in puberty for girls
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1. breast bud appears
2. pubic hair appears 3. growth spurt 4. axillary hair 5. pubic hair matures 6. breasts mature 7. menarche 8. adult height |
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3rd indicator of pubertal delay
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-malnutrition or anorexia nervosa severe enough to delay puberty
-possibility of hypopituitarism or turner syndrome -reduced sense of smell-- kallmann syndrome--> hypogonadotropic hypogonadism |
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precocious puberty
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white females 7 and younger
black females 6 and younger boys 8 and younger |
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treatment of gynecomastia
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pubertal <4cm: reassurance, education, observation, regression usually.
pubertal >4cm surgical treatment may be indicated, esp if present for >4 years |
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Target or midparental height
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girls:
mother's height + (father's height--5 in)/2 boys: father's height + (mother's height + 5 in)/2 |
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abnormal growth findings suggesting the need for referral
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1. height: growth less than the 3rd percentile or greater than the 95th percentile
2. growth velocity: decreased or increased for age 3. genetic potential: projected height varies from midparental height by more than 5cm (2in) 4. multiple syndromic or dysmorphic features: abnormal facies, midline defects, body disproportions 6. bone age: advanced or delayed by more than 2 SD |
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Bone age can be delayed with:
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-constitutional growth delay (a variation of normal growth pattern)
-growth failure due to GH deficiency and hypothyroidism -emotional deprivation, chronic illness, malnutrition |
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Bone age can be advanced with:
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-prolonged elevation of sex steroid levels (as in precocious puberty or congential adrenal hyperplasia)
-with premature adrenarche (when a child is overweight from a young age or when a child has lipodystrophy) -in genetic overgrowth syndromes, such as sotos syndrome, beckwith-wiedemann syndrome and marshall-smith syndrome -hyperthyroidism |
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genetic/familial short stature
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-normal variant
-falls of growth curve at about 9-18 mo, then resumes normal growth velocity -**bone age = chronological age -growth rate >4cm/yr -no pubertal delay -deceleration of height but not necessarily weight w/in 1st 2 yrs -final height short but appropriate for family |
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constitutional delay
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-normal variant
-most common cause of short stature -falls off growth curve at 9-18 mo, then resumes normal growth velocity -**bone age delayed and approximately = to height age -pubertal maturation delayed -delayed pubertal growth spurt often occurs b/w 15-17yrs of age, and growth continues until 18-20 yrs of age |
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endemic cretinisim
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most common cause of mental retardation world wide. Caused by iodine deficiency
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Upper motor neuron lesion
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-lesion of the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves
-usually associated with spastic paralysis (severe hypertonia) -spasticity-- stiffness/tightness of muscles -pyramidal weakness-- muscle weakness -brisk DTRs, hyperactive, babinski present -pronator drift |
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Lower motor neuron lesion
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-affects nerve fibers traveling from the anterior horn of the spinal cord to the relevant muscle
-usually associated with flaccid paralysis (muscle loss) -muscle paresis or paralysis -fibrillations -fasciculations (twitching) -hypotonia or atonia -reflexes difficult to elicit -areflexia or hyporeflexia -trauma, polio, myasthenia gravis, muscular dystrophy |
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Acute UMN lesions infants will present with....
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hypotonia initially with hypertonia occurring later
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when evaluating a patient with migraines..if pt has papilledema and a normal MRI.. what must you r/o?
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do a LP to diagnose pseudomotor cerebrii ( a neuro d.o that is caused by pressure exerted around the brain, despite the absence of a tumor)
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if a patient has a febrile seizure, what must you r/o?
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meningitis--- get a LP, CBC, blood cultures
also CMP, glucose, calcium, imaging |
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Headache red flags "SNOOP"
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-systemic: fever, wt loss, secondary headache risk factors (HIV, cancer)
-Neuro S/S; confusion, impaired alertness or consciousness -onset: sudden, abrupt, or split second -older: new onset and progressive headache, esp in adult >50 -1st headache, different headache, change in attack frequency, severity, or clinical features |
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HPV vaccine-- Gardasil
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--females and males 9-26 yo
--covers 4 types of HPV: 6, 11, 16, 18 --3 doses: 2nd dose given 1-2 mo after 1st dose; 3rd dose given 6 mo after 1st dose -contraindicated in pts with yeast allergies -Types 6 and 11 cause 90% of genital warts -Types 16, 18 causes 70% cervical cancers |
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HPV vaccine--Cervarix
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--females 10-25 yo
--covers types 16, 18 (cervical cancer) --3 doses: 2nd dose given 1-2 mo after 1st dose; 3rd dose given 6 mo after 1st dose |
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once a person has sx of varicella, the illness cannot be prevented.. Since symptoms of varicella usually begin 14-16 days after exposure (range 10-21 days), there can be time to help prevent or decrease the severity of the illness through administration of the varicella vaccine. the vaccine is effective if only ___ days has passed since exposure.
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fewer than 3 days (possibly up to 5 days)
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If only ___ days have elapsed since a susceptible person has been exposed to VZV, VZIG can be used for postexposure prophylaxis.
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4 days (96 hours)
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VZIG vaccines provides only passive, temporary immunity. To provide future protection to people who remain susceptible to varicella, varicella vaccine should be given ____months after VZIG administration.
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5 months.
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A susceptible person is infected with VZV. Typically, during which days after exposure could this person be considered infectious?
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from day 12 until the day the lesions are crusted.
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Once a person has developed symptoms of acute varicella, it is not possible to prevent the illness. What drugs can be prescribed to reduce: the number of days during which new lesions appear, the duration of fever, and the severity of cutaneous and sytemic s/s
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antiviral drugs
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Routine varicella vaccine in children?
adults? |
Children
1st dose: 12-15 months 2nd dose: 4-6 years old (may be given earliar, if at least 3 months after the 1st dose) Adults: 13 yo and older who have never had chicken pox or received chicken pox vaccine should get 2 doses at least 28 days apart |
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what are some adverse reactions to varicella vaccine?
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mild
soreness or swelling where the shot was given, fever, mild rash moderate seizure (jerking or staring) caused by a fever (very rare) severe pneumonia (very rare) other serious problems include brain reactions and low blood count |
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zoster vaccine is licensed for what age?
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60 yo and older
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Routine schedule for polio vaccine for children?
adults? |
4 doses for children:
2 months, 4 months, 5-18 months, 4-6 years old *the final dose in polio vaccine series should be administered at age 4 yrs old or older regardless of the number of previous doses. 3 doses for adults: -dose 1 -dose 2, given 1-2 months later -dose 3, given 6-12 months after dose 2 *accelerated schedule is IPV q 4 weeks x3 doses |
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Routine polio vaccination of people in the US who are older than 18 yo of age is not recommended. Most adults already are immune to polio and there is almost no risk of exposure to wild poliovirus in the U.S. There are 4 situations in which administration of IPV to adults whould be considered:
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1. traveling to areas in the world where there is a high risk of exposure to wild poliovirus
2. work in laboratories where they may handle specimens that contain poliovirus 3. are healthcare workers coming in to close contact with people who may be excreting wild polioviruses 4. are members of communities or specific population groups with disease caused by wild polioviruses *these adults must received 3 doses of IPV |
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what is the policy of polio vaccine in military personnel?
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-all military personnel must receive a booster dose
-if full series of poliovirus vaccination were not given, then they must receive the full primary series -dose 1 -dose 2, given 1-2 months later -dose 3, given 6-12 months after dose 2 *accelerated schedule is IPV q 4 weeks x3 doses |
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True or False
UP to 95% of polio infections are symptomatic |
False
95% have no symptoms |
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when are you infectious with polio?
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7-10 days before and after onset of symptoms, but the poliovirus may be present in the stool from 3-6 wks or longer
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some people should not not get IPV
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-life threatening allergic reaction to the abx: neomycin, streptomycin, polymyxin B
-allergic reaction to previous polio shot |
