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448 Cards in this Set
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Regarding the feeding of a 12h old infant:
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the baby may need to be awakened to be fed; the urine should be light or colorless
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advantages of breastfeeding:
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lower diarrheal illness, lower risk of allergic disorder and constipation; there is LESS weight gain in the first few weeks, though
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at 3 weeks, the average formula-fed infant should take:
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2-3oz every 2-3h
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most drugs pass through breast milk via:
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simple diffusion; usually only 1% of maternal dose
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anticipated average daily weight gain during the first 3m:
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30g/d
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in US, ___% of infants are breastfed at birth, with ___% continuing by 6m.
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60% at birth; 25% continuing at 6m
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frequency of feeding during months 1 and 2:
breastfed: bottlefed: |
breastfed >=10m/breast q 1.5 - 3 hours
bottlefed: 2-3oz q 2-3h |
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signs of readiness for solid food:
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doubled birth weight AND at least 4-6m
>32oz formula/d or more than 8-10 feedings per day (breast or bottle) |
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POP advantage over Combined Oral Contraception:
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no alteration in breast milk quantity or quality
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a 3m/o would:
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experiment with sound
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a 3-5m/o infant can:
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bring hands together
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a 9-11m/o infant can:
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play peek-a-boo
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a 2y/o can _____ verbally:
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speak in phrases of two or more words
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a child would imitate housework at how many months?
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15 months
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a 3 y/o can:
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give first and last names
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a 6-7m/o infant can:
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roll back to stomach
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a 9m/o infant can:
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recognize own name
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a 3y/o can:
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alternate feet when climbing stairs
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visually, in a NB, there should be:
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best vision at 8-12", presence of red reflex, light-sensitive eyes, defensive blink
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at 2w/o, an infant has a visual preference for what?
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the human face
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at 5y/o, what about friends:
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child can name a Best Friend
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anticipatory guidance for parents of a teething infant at:
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4-6m
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advice about temper tantrums at:
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10-12m
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advice about time outs at:
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18-24m
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guidance about protection from falls at:
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at birth
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NB reflexes:
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tonic neck, palmar grasp, babinski, rooting, sucking
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at 1-2 m, a child can:
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lifts head and holds it erect, regards face, follows objects visually; smiles and recognizes parents
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at 1-2 m, the following reflexes are fading:
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moro and palmar reflexes fade at 1-2m
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at 3-4 m, a child can:
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grasp and reach for things, bring objects to mouth, RASPBERRY SOUND; LAUGHS, SQUEALS, and vocalizes; rolls back to side
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at 5 m, a child can:
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keep back straight when sitting, bears weight when standing, sits with support; imitates
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at 6-8 m, a child can:
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SIT WITHOUT SUPPORT, scoop using rake grip, hand-to-hand transfer, wave "BYE BYE", STRANGER AND SEPARATION ANXIETY begins (at 6m), pulls feet to mouth; coughs and snorts to attract attention, ROLLS BACK TO STOMACH AND VICE VERSA, UNDERSTANDS "NO"; chains together syllables, but no meaning
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at 9-11m, a child can:
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CRAWL AND CREEP, STAND initially by holding onto furniture, then later solo, "PEEK A BOO" AND "PAT A CAKE", picks up objects with pincer grasp; cruises, follows simple commands, says "MAMA" AND "DADA" WITH MEANING
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at 12-15m, a child can:
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initially walks with help, later WALKS SOLO, neat pincer grasp, hands over objects upon request, stacks two bricks; SAYS ONE TO TWO WORDS, points out desires, scribbles, imitates animal sounds
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at 15-20m, a child can:
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point to body parts, THROW OVERHAND, seat self, climbs; uses a spoon messily, up and down steps clumsily, understands TWO-STEP COMMANDS, feeds self, carries doll, IMITATES HOUSEWORK; 4-6 WORD VOCABULARY AT 15 M and up to >10 words by 18 m, builds 3 cube tower
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at 24m, a child can:
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speak in SENTENCES OF >=2 WORDS, kicks ball on request, JUMPS WITH BOTH FEET, PRONOUNS, HANDEDNESS STARTS TO DEVELOP; runs, copies lines, 300 WORD VOCABULARY, washes / dries hands, parallel play, dresses with simple clothing
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double weight by ___ months.
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6 months to double weight
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triple weight by ___ months.
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12 months to triple weight
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% of overweight children
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12%
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at 30 months a child can:
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walk backward, hop on one foot, copy a circle; can give first and last name, uses plurals, separates easily from parents
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at 36 months, a child can:
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almost all speech is intelligible to everyone, three-word sentences, rides tricycle, dresses with supervision
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3-4 years, a child can:
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responds to commands about object placement, KNOWS GENDER, takes off jacket and shoes, washes and dries face, coop play, uses PLURALS, PERSONAL PRONOUNS, VERBS, SKIPS, many questions!
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4-5 years, a child can:
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run, turn and maintain balance, stand on one foot, count to 4, draws person without torso; buttons clothes, dresses self, plays without adult input for 30 minutes
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5-6 years, a child can:
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catch a ball, knows age and right from left hand, draws person with 6-8 parts and torso, ID best friend, likes teacher; completes simple chores
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6-7 years, a child can:
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copy triangle, draw a person with 12 parts, prints name, reads multiple syllable words; ties shoelaces, counts to >= 30, plays well with others, no behavioral problems at school, names intended career
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7-8 years, a child can:
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copy diamond, READ SIMPLE SENTENCES, draws person with 16 parts; TIES SHOES, KNOWS DAYS of the week
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at 8-9 years, a child can:
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RESPOND WHEN ASKED WHAT TO DO ABOUT A BROKEN OBJECT; can ADD, SUBTRACT, BORROW, CARRY, WORK AS A TEAM; can multiply and do complex subtraction
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at what age does a child know day, month, and year, gives months in sequence
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9-10 years
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at 10-12 years, a child can:
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puberty begins for girls; complex reading skills
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toilet training guidance for parents when child is ____?
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18 months
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MMR vaccine is:
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LAV; 2 doses: 12-15m and, again, at 4-6y; 2 immunizations one month apart recommended for older non-immunized children
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Rubella's aka
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German Measles
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Rubella's acute illness is:
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3-5 days, mild, very low risk for person infected;
BUT TERATOGENIC TO FETUS! (congenital Rubella syndome) |
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Rubeola's aka:
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Measles
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Measles's acute illness is:
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severe illness with sequelae: encephalitis, pneumonia
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Mumps's sequelae:
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orchitis
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immunization against influenza is ___ effective.
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70-80% effective
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Hep B vaccine, number of doses:
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3 doses for HBV
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Hep B vaccine schedule:
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birth
1-2m 6-18m |
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Rotavirus vaccine, number of doses:
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3 doses for rotavirus
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Posterior fontanel closes:
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birth to 2 months (8 weeks)
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Anterior fontanel closes
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9-18 m
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5-10% of children have __ problems
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vision problems
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at birth, neonates head is:
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2" bigger than chest circumference
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cover / uncover test for:
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amblyopia (strabismus)
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congenital cataracts, look for:
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red reflex
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begin formal vision screening at:
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4 years old: Snellen chart
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at 3 years old, vision is 20/50; it is 20/20 at ___:
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6 years old
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cooperative 4 years old, hsould have visual acuity assessed via:
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monocular vision ("Tumbling E's") to check individual eyes
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RF's for vision problems
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premie, dev. Delay, family history of vision problems
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most common congenital problem at birth:
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hearing loss, more often in premies
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15% of children 6-19 years old have hearing loss
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TRUE
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first teeth at:
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6 months old
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all teeth erupted by:
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2 years old
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secondary teeth first start by:
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6-8 years old, starting on bottom; these erupt up to 17 years old
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NB jaundice:
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never should be at birth
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neurofibromatosis aka
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Von Recklinghausens; café au lait spots, neuro problems
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hyperbilirubinemia in NB:
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red cells lysed during trauma of birth, bilirubin >5, deposits under skin
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bilirubin peaks in NB:
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3-4th day
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treatment hyperbilirubinemia:
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keep breastfeeding, Hydrate, phototherapy
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developmental screening at:
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9 m/o, 18 m, and 2 1/2 y/o
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autism screen:
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18 months old and 2 years old
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HR reaches slower rate at:
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6 years old
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coarctation of the Aorta:
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narrowed aorta, blood passing through is very high pressure (high BP in UE); but LOW BP in LE
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routine exam for 3 years old:
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First BP screen!
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hydrocele assessment via:
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transillumination; glows with fluid (+); referral if unresolved by 12 months old
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MSK problems in children, hip, what tests?
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Ortolani's: 2-5th fingers on greater Trochanter feeling for click or clunk, EXTERNALLY rotate, if have hip dysplasia, it will be displaced upward
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Barlow's test for:
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hip dysplasia; Barlow's: same position, internally rotate hip: "Barlow's Butt"
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unequal gluteal folds:
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hip dysplasia
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talipes equinavarus:
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refer
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metatarsus adductus:
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intoeing at arch; ensure that it is "flexible" metatarsus (can bring foot to midline), refer if rigid metatarsus
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scoliosis defined:
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>= 10 degree curvature of spine, most common in growth spurt, use Adam's Forward Bend Test BEFORE pubertal growth spurt
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MMR and VAR schedule?
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12-15m, 4-6y
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HAV Series, # of doses?
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2
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HAV Series, schedule:
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2 doses, beginning at 12-24m; given at least 6m apart
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MCV vaccine indications:
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for 2-10y with immunodeficiency; for ALL 11-12y, all prev. unvaccinated college dorm freshman
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HBV vaccine contraindication if anaphylaxis to:
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baker's yeast
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infants with HBV have ___% chance of developing hepatocellular carcinoma or cirrhosis.
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25% chance
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HBV transmitted easiest via:
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body fluids
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VZV vaccine can reduce risk of:
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shingles, Reye syndrome, invasive varicella
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___% of people who develop shingles at least once after chickenpox.
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15% develop shingles
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for an 11y without primary tetanus series, what is the vaccination model?
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tet, dipth, and acellular pertusis vaccine (Tdap) x 1 dose, with doses of TD vaccine in 1 and 6 months
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pseudomembranous colitis causative organism:
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corynebacterium diptheriae
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tetanus causative organism:
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clostridium tetani (anaerobe, G+, in soil and manure)
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at what age to begin screening for lead poisoning?
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6m
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intervention for infant with lead levels of 10-20mcg/dL
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chelation therapy
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intervention for infant with lead levels of 40-50 mcg/dL
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chelation therapy
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intervention for infant with lead levels from 10-35mcg/dL
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removal from lead source, improved nutrition, iron tx
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intervention for infant with lead levels >51mcg/dL
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hospital admission and expert evaluation
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bronchiolitis etx:
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RSV
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#1 sx of bronchiolitis:
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wheezing: narrowing and obstruction of small airways with resulting cough and wheezing
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bronchiolitis characteristics:
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2-3w of mild URT sx with expiratory wheezing; tx: supportive; long-term sequelae include recurrent airway reactivity
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capillary hemangioma resolution?
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increase in size in first year of life; NOT present at birth - appear in first weeks afterward; 90% disappear by 9y; tx with removal if large, on vital organ or area or eye - otherwise leave alone
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port wine stain is a:
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flat hemangioma, present at birth; grows proportionately, deepen in color with time
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Mongolian spots occur in:
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90% of AA and Asians, low back and buttocks, benign, fade by 7y
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1st line for AOM as antibiotic?
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amoxicillin
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most AOM caused by:
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certain G+ and G- bacteria and respiratory viruses
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if child has bacterial AOM AND a Type I (severe) PCN allergy, what to prescribe?
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azithromycin, clarithromycin (macrolides); or ceftriaxone (cephalosporin)
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if child has bacterial AOM AND a NON-Type I PCN allergy, what to prescribe?
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cefdinir, cefuroxime, cefpodoxime (cephalosporins)
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RF for recurrent AOM in young children:
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pacifier after 10m, hx of 1st episode of AOM at <3m, second-hand smoke, feeding in supine position
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most effective antimicrobial against Streptococcus Pneumoniae:
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cefuroxime (cephalosporin)
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if failure of tx in AOM after 3d of amox/clavulanate, what is recommended?
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IM ceftriaxone
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m/c finding in AOM:
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TM immobility to insufflation
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absent in OME?
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fever
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sx in OME?
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fluid in middle ear, otalgia, itch
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clindamycin is most effective against:
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streptococcus pneumoniae
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h. influenzae and m. catarrhalis are G- with resistance via:
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beta-lactamase production
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in child <3m with AOM, when f/u?
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1-2d due to increased risk of tx failure
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indication of tx failure in AOM in children >3m?
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otalgia, fever, etc. existing beyond 3 days of tx
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OME dx:
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fluid in middle ear in absence of signs of acute infection; 80% clear by 8w
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m/c finding in UTI in young child:
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fever
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UTI organisms that can reduce nitrates to nitrates:
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e. coli, proteus species, k. pneumoniae
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antimicrobial of choice for UTI:
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2nd or 3rd generation cephalosporin or, if severe PCN allergy, an aminoglycoside
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major RF for UTI in children:
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urinary tract abnormality (vesicoureteral reflux in <=50% of these cases)
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rubella sx:
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mild: 3-5d hx of sore throat, low-grade fever, maculopapular rash, cervical / occipital LAD (remember: congenital rubella syndrome is teratogenic)
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fever, exudative pharyngitis, ant. cervical LAD, and a fine, raised, pink rash is which illness?
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scarlet fever (caused by streptococcus pyogenes (GABHS))
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if severe sx in mononucleosis, what is prescribed?
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prednisone PO (nml tx is supportive for mono)
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1-day hx of fiery red, maculopapular facial rash on cheeks, mild HA and myalgia for one past week
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erythema infectiosum
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asthma, defined:
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chronic airway inflammation with superimposed bronchospasm
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roseola causative agent:
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HHV-6
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roseola characteristics:
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rosy-pink macular or maculopapular rash from hours to 3d FOLLOWING 3-7d of high fever
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roseola tx:
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supportive
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hand foot and mouth disease causative agent:
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coxsackievirus A16
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HFandM disease characteristics:
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fever, malaise, sore mouth, pustules on hands and soles; lasts 2-7d; transmitted via fecal-oral; highly contagious; supportive tx
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fifth disease causative agent:
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human parvovirus B19
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fifth disease m/c presentation:
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3-4d mild flu, followed by a red rash starting on face "slapped cheek" appearance; leukopenia, supportive tx
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infectious mononucleosis causative agent:
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EBV (HHV-4)
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mono presentation:
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maculopapular rash in 20%, purple-white exudative pharyngitis, malaise, marked diffuse LAD, hepatic and splenic tenderness; 90% develop rash if given amoxicillin (it's virus, Dude!); supportive tx, but may use systemic corticosteroids
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acute HIV presentation
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maculopapular rash, fever, mild pharyngitis, ulcerating oral lesions, diarrhea, diffuse LAD
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if mono, avoid what for >=1m?
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contact sports for risk of splenic rupture
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Kawasaki disease causative agent:
|
UNKNOWN!
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Kawasaki disease characteristics:
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lasts 11d, high fever (>104) for >=5d; polymorphous exanthem on trunk and flexor areas, "strawberry tongue", extensive lip chapping, bilat conjunctivitis WITHOUT d/c, cervical LAD, erythema of hands / feet with SKIN PEELING
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Kawasaki disease tx:
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(occurs mostly in 1-8y); IV IG and PO ASA during acute phase (reduces risk of coronary A. dilation and aneurysm); expert consult about ASA use
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RF's for asthma death include:
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hospital admission or ER visit for asthma in past month, current use of systemic corticosteroids or recent withdrawal from them, difficulty perceiving airflow obstruction or severity
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crawl and creep at how many months?
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9-11m for crawl and creep
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peek a boo and pat a cake at how many months?
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9-11m for peekaboo and patacake
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says mama and dada with meaning at how many months?
|
9-11m
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follows simple commands at ___ m/o?
|
9-11m
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can run, turn, and balance at what age?
|
4-5y
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count to 4 at what age?
|
4-5y "count to 4 at 4"
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buttons clothes and dresses self at what age?
|
4-5y
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plays without adult input for 30 minutes at what age?
|
4-5y
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backbone tx for mild persistent, moderate persistent, or severe persistent asthma
|
inhaled corticosteroid; could mast cell stab. (cromolyn) or LKT modifiers (montelukast, zafirlukast)
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effects for corticosteroids or LKT modifiers take place in:
|
1-2w
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|
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a LABA example:
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formoterol, salmeterol
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a SABA example:
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albuterol, levalbuterol (better than the other two: greater bronchodilation at a lower dosage with fewer SE's), pirbuterol
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asthma, clarified:
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a lower airway disease, more problems with expiration - "air trapping"
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asthma, findings:
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decreased PEF, prolonged expiration, thoracic hyperresonance on percussion, hyperinflation seen on xray; O2 desat is a LATE finding
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sx onset for food poisoning with Staph:
|
1-4h
|
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sx onset for food poisoning with salmonella:
|
12-24h
|
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% of body weight lost in child with moderate dehydration:
|
6-10%
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shigellosis clinical features:
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bloody diarrhea, high fever, malaise; NOT vomiting
|
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acute gastroenteritis characteristics:
|
<4d, N/V/D, no blood or pus, highly contagious, almost always VIRAL; determine hydration status via "When was the last urination?"
|
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premature thelarche is:
|
early breast development; relatively common
|
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premature andrenarche is:
|
early pubic hair growth
|
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precocious puberty in girls, onset is:
|
<8y
|
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girls achieve all height by:
|
1 year after first menses
|
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precocious puberty in boys, onset is:
|
<9y, refer, as this is most likely a gonadal or adrenal tumor
|
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murmur of ASD is:
|
first found on a 2 to 6 month WC exam
|
|
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for low-pitched heart sounds, use
|
bell of stethoscope
|
|
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for high-pitched heart sounds, use
|
diaphragm of stethoscope
|
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|
body temp. increase from fever causes:
|
lower viral replication rates, toxic effect on certain bacteria, negative effect on S. pneumonia growth
|
|
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in aseptic / viral meningitis, the CSF will have:
|
predominance of lymphocytes
|
|
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sepsis, defined:
|
clinical manifestation of systemic infection
|
|
|
febrile seizure occurs at what point in illness?
|
most likely to occur as fever is increasing, rather than at its peak
|
|
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seizures in first 2y of life?
|
yes, commonly 4-6 acute febrile episodes per year (parents seek health care in 2/3 of cases)
|
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if fever persists, should RTC, when:
|
1-2d; sooner if fever worsens
|
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onset of action of IBU and APAP
|
within 30m
|
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duration of APAP action
|
4h
|
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duration of IBU action
|
6h
|
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antipyretic effects of IBU and APAP at lower grade fevers (<102.5):
|
equivalent
|
|
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antipyretic effects of IBU and APAP at higher grade fevers (>102.5):
|
IBU has greater antipyretic potential than APAP during higher fevers
|
|
|
used during varicella outbreak
|
APAP, because IBU is implicated in necrotizing fasciitis
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if sepsis is suspected, what is empirical antimicrobial tx?
|
IM ceftriaxone at 50mg/kg q 24h + gentamicin + supportive care, need culture and sensitivity
|
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"left shift" causes:
|
severe bacterial infection, appendicitis, pneumonia
|
|
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bacterial infection look on CBC with differential:
|
leukocytosis, neutrophilia, bandemia; toxic granulation; REALLY BAD if:myelocytes or metamyelocytes are seen
|
|
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viral infection look on CBC with differential:
|
total WBC usually nml, lymphocytes predominate
|
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CSF results in viral infection:
|
nml glucose, lymphocytosis, probably normal protein levels
|
|
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tx of suspected aseptic / viral meningitis:
|
acyclovir, seek help
|
|
|
tx of suspected septic / bacterial meningitis:
|
ceftriaxone with vancomycin; pending bacterial sensitivity results; seek help
|
|
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m/c pathogen in CAP in child:
|
virus
|
|
|
most appropriate antimicrobial for CAP in 2y/o:
|
azithromycin
|
|
|
% of children who have pneumonia by age 5?
|
20%
|
|
|
antimicrobial effective agains atypical pathogens of pneumonia?
|
clarithromycin
|
|
|
umbilical hernia
|
common in AA; should be easily reducible; refer if still present at 12 months
|
|
|
unless it's detrimental, encourage cultural practices
|
TRUE
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|
neuro assessment at:
|
12m
|
|
|
tanners staging:
|
1: completely immature; 5: mature
|
|
|
breast buds:
|
T II for girls
|
|
|
maturation in males, order:
|
pubic, axillary, then facial hair
|
|
|
first sign of pub in girls
|
breast dev
|
|
|
first sign of pub in boys
|
testes enlarge
|
|
|
reporting suspected child abuse:
|
your duty to report supersedes pt confidentiality
|
|
|
2m old child
|
grasp finger, look at faces, can't really support head
|
|
|
4m old with head
|
can hold upright
|
|
|
4m old, eating
|
can start eating solid food
|
|
|
anticipatory guidance about teething:
|
at 4m; teeth start erupting at 6m
|
|
|
crawl, creep, and scoot at what age?
|
9m
|
|
|
walk, stoop, stack blocks
|
15m
|
|
|
throw a ball
|
18m
|
|
|
no limit to fat in diet of child until what age?
|
1y; start "going light" at that point
|
|
|
toddler age is:
|
2-3y
|
|
|
4y old is considered a:
|
preschooler
|
|
|
average 2 year old vocal:
|
20 words
|
|
|
good toy for a 2 y/o:
|
ball
|
|
|
good toy for a 3 y/o:
|
tricycle
|
|
|
preschoolers age =
|
4-5y
|
|
|
school-age =
|
>=6y
|
|
|
good toy for a 4y/o
|
scissors with round edges
|
|
|
able to draw body with all parts at what age:
|
5y
|
|
|
at what age can a child know their address:
|
5y
|
|
|
6-10y aka
|
school-age
|
|
|
counseling about tobac/alcohol and drugs starts at:
|
6-10y
|
|
|
average 8 year old should start:
|
wearing seat belt
|
|
|
average 10 year old should start:
|
chores at home
|
|
|
adolescents age:
|
11-~21y
|
|
|
all sexually active adolescents should have annual
|
UA. looking for leukocytes d/t chlamydial infection
|
|
|
for routine wellness exam of 15 y/o, how to interview:
|
alone AND with parents
|
|
|
ecchymosis of scalp, no cross
|
cephalohematoma
|
|
|
nml finding at 12m
|
palpable anterior fontanel
|
|
|
stepping reflex disappears at what age?
|
9m
|
|
|
primary dentition from:
|
6-24m
|
|
|
breast buds:
|
T II
|
|
|
infants age:
|
1-11m
|
|
|
routine NB screening tests:
|
PKU, congenital hypothyroid, Sickle Cell
|
|
|
nml to lose how much body weight in first 3d of life?
|
~10%
|
|
|
TDaP always given at:
|
11-12y
|
|
|
Skip HiB at 4y, if they've never gotten the illness or the vaccine
|
TRUE
|
|
|
if 13y, but no varicella vaccine AND no chickenpox hx:
|
get 2 vaccines: 1 now and one a month later
|
|
|
HBV vaccine can be given:
|
at any age
|
|
|
common tetanus SE:
|
local tenderness
|
|
|
2 live or 2 attenuated or one of each vaccine: how are they given?
|
be given together or at least one month apart
|
|
|
how many hours after puncture can a Tet vaccine be given?
|
72h
|
|
|
MMR vaccine dead or attenuated:
|
attenuated!; not for immunocompromised or pregnant; always produces rash about 4 days later
|
|
|
if allergic to eggs, can still get flu shot, but NOT if
|
anaphylaxis to eggs!
|
|
|
m/c pathogen in CAP:
|
streptococcus pneumonia
|
|
|
m/c sx in children with CAP:
|
tachypnea; order chest xray
|
|
|
mycoplasma pneumonia:
|
needs macrolide; is an atypical pathogen in CAP
|
|
|
in both adults and children with bronchitis or bronchiolitis:
|
starts in upper tract, moves to lower
|
|
|
commonly seen with bronchiolitis:
|
upper, then lower airway problems; #1 wheezing, erythematous ears, atelectasis; it IS VIRAL: supportive care, SABA for wheezing; give steroids if respiratory tubule edema (know that they won't recover as quickly with steroids)
|
|
|
croup:
|
viral; kids get it d/t respiratory tubule diameter; "barking cough"
|
|
|
epiglottitis
|
difficulty swallowing, drooling
|
|
|
lead toxicity masquerades as:
|
IDA
|
|
|
m/c form of cancer in children:
|
ALL, AML
|
|
|
leukemia =
|
bone marrow failure: look at RBC's, WBC's, and PLT
|
|
|
if considering leukemia,
|
HGB/HCT, CBC; then REFER
|
|
|
bruising, bleeding, epistaxis, think
|
PLT problems
|
|
|
recurrent infections, swollen lymph nodes, think:
|
WBC problems; palpate spleen and liver - look for enlargement
|
|
|
projectile vomiting in kid:
|
projectile vomiting; olive mass in RUQ; m/c in first-born males
|
|
|
encopresis is
|
involuntary BM's; think constipation in boys, think sexual abuse in girls
|
|
|
laxatives used:
|
short term, to establish pattern; use miralax to get them to at least one soft BM / day, then wean off
|
|
|
most effective mgmt. of enuresis:
|
bed-wetting alarm; second is desmopressin / DDVAP
|
|
|
mild dehydration, tx:
|
50mg/kg in 4 hours; Pedialyte
|
|
|
cryptorchidism is dx'd via:
|
PE
|
|
|
if testicle is undescended,
|
REFER at time of dx
|
|
|
most significant murmurs are
|
diastolic: use diaphragm AND bell; move pt around (redirects blood flow) - if after moving the murmur disappears, that is a good sign
|
|
|
if child has murmur, be sure to check:
|
for sx (ex intolerance, chest pain, speeds up and slows down) and Check GROWTH CHART (very significant if on low end with murmur)
|
|
|
murmurs tend to occur where they are heard
|
TRUE
|
|
|
murmur with Down's
|
very significant, cardiac pathology
|
|
|
meds for child with HTN:
|
as with adults, except, if adolescent watch out for ACEI and ARB (TERATOGENIC in first trimester of pregnancy); BB, CCB, Thiazides are all fine
|
|
|
hyperlipidemia in children
|
screen
|
|
|
Legg-calv-perthes
|
in pre-adolescents; osteonecrosis of hip: hip, knee or both pain
|
|
|
trendelenberg sign in kids
|
look for a "dip in the hip" when child lifts opposite foot from floor when standing; suspect hip problems (hip X-ray)
|
|
|
hip pain secondary to SCFE:
|
hip, knee pain and or both; limp; much more common than LCP in hip
|
|
|
transient synovitis
|
m/c cause of hip pain, benign, (-) on X-ray; supportive tx; often occur with hx of URTI; will disappear within 2 weeks
|
|
|
pt with diaper dermatitis may also have:
|
thrush
|
|
|
Koplik spots goes with
|
measles (Rubeola); fine macular rash on trunk (blanches)
|
|
|
"strawberry tongue" with
|
strep throat
|
|
|
viral exanthem
|
Fifth disease (lacy macular rash (blanches)), Roseola; all except chick can return to school 24h after temperature is resolved; for chick, must wait until all sores have crusted over
|
|
|
oral ulcerations with short-term fever
|
herpangina; give APAP to reduce throat pain so they'll drink and not get dehydrated
|
|
|
chickenpox rash starts:
|
rash starts on trunk
|
|
|
maculopapular rash occurs two days after resolved temperature is what illness?
|
roseola (a viral exanthem)
|
|
|
m/c of AOM:
|
viral; when bacterial its strep pneumo (use amoxicillin)
|
|
|
rupture of TM finding:
|
otic d/c (usually with odor)
|
|
|
for AOM, abx:
|
amoxicillin 80-90mg/kg/d; unless suspecting beta-lactamase producer like if used abx in past 30d
|
|
|
if suspecting beta-lactamase organism in AOM, use:
|
augmentin, 3rd or 4th gen cephalosporin; + topical analgesic for ear (Auralgan) and oral analgesic
|
|
|
don't alternate APAP and IBU because:
|
pt will likely make a med error AND, if sick enough to need something q 2-4h for pain they'll likely be dehydrated: APAP and IBU will be very hard on the kidneys (they MUST be well-hydrated!)
|
|
|
1 y/o with AOM, tx with abx for how many days?
|
10d
|
|
|
PSGN may develop after:
|
either throat OR skin strep infection
|
|
|
crawl and creep at how many months?
|
9-11m for crawl and creep
|
|
|
peek a boo and pat a cake at how many months?
|
9-11m for peekaboo and patacake
|
|
|
says mama and dada with meaning at how many months?
|
9-11m
|
|
|
follows simple commands at ___ m/o?
|
9-11m
|
|
|
can run, turn, and balance at what age?
|
4-5y
|
|
|
count to 4 at what age?
|
4-5y "count to 4 at 4"
|
|
|
buttons clothes and dresses self at what age?
|
4-5y
|
|
|
plays without adult input for 30 minutes at what age?
|
4-5y
|
|
|
backbone tx for mild persistent, moderate persistent, or severe persistent asthma
|
inhaled corticosteroid; could mast cell stab. (cromolyn) or LKT modifiers (montelukast, zafirlukast)
|
|
|
effects for corticosteroids or LKT modifiers take place in:
|
1-2w
|
|
|
a LABA example:
|
formoterol, salmeterol
|
|
|
a SABA example:
|
albuterol, levalbuterol (better than the other two: greater bronchodilation at a lower dosage with fewer SE's), pirbuterol
|
|
|
asthma, clarified:
|
a lower airway disease, more problems with expiration - "air trapping"
|
|
|
asthma, findings:
|
decreased PEF, prolonged expiration, thoracic hyperresonance on percussion, hyperinflation seen on xray; O2 desat is a LATE finding
|
|
|
sx onset for food poisoning with Staph:
|
1-4h
|
|
|
sx onset for food poisoning with salmonella:
|
12-24h
|
|
|
% of body weight lost in child with moderate dehydration:
|
6-10%
|
|
|
shigellosis clinical features:
|
bloody diarrhea, high fever, malaise; NOT vomiting
|
|
|
acute gastroenteritis characteristics:
|
<4d, N/V/D, no blood or pus, highly contagious, almost always VIRAL; determine hydration status via "When was the last urination?"
|
|
|
premature thelarche is:
|
early breast development; relatively common
|
|
|
premature andrenarche is:
|
early pubic hair growth
|
|
|
precocious puberty in girls, onset is:
|
<8y
|
|
|
girls achieve all height by:
|
1 year after first menses
|
|
|
precocious puberty in boys, onset is:
|
<9y, refer, as this is most likely a gonadal or adrenal tumor
|
|
|
murmur of ASD is:
|
first found on a 2 to 6 month WC exam
|
|
|
for low-pitched heart sounds, use
|
bell of stethoscope
|
|
|
for high-pitched heart sounds, use
|
diaphragm of stethoscope
|
|
|
body temp. increase from fever causes:
|
lower viral replication rates, toxic effect on certain bacteria, negative effect on S. pneumonia growth
|
|
|
in aseptic / viral meningitis, the CSF will have:
|
predominance of lymphocytes
|
|
|
sepsis, defined:
|
clinical manifestation of systemic infection
|
|
|
febrile seizure occurs at what point in illness?
|
most likely to occur as fever is increasing, rather than at its peak
|
|
|
seizures in first 2y of life?
|
yes, commonly 4-6 acute febrile episodes per year (parents seek health care in 2/3 of cases)
|
|
|
if fever persists, should RTC, when:
|
1-2d; sooner if fever worsens
|
|
|
onset of action of IBU and APAP
|
within 30m
|
|
|
duration of APAP action
|
4h
|
|
|
duration of IBU action
|
6h
|
|
|
antipyretic effects of IBU and APAP at lower grade fevers (<102.5):
|
equivalent
|
|
|
antipyretic effects of IBU and APAP at higher grade fevers (>102.5):
|
IBU has greater antipyretic potential than APAP during higher fevers
|
|
|
used during varicella outbreak
|
APAP, because IBU is implicated in necrotizing fasciitis
|
|
|
if sepsis is suspected, what is empirical antimicrobial tx?
|
IM ceftriaxone at 50mg/kg q 24h + supportive care, need culture and sensitivity
|
|
|
"left shift" causes:
|
severe bacterial infection, appendicitis, pneumonia
|
|
|
bacterial infection look on CBC with differential:
|
leukocytosis, neutrophilia, bandemia; toxic granulation; REALLY BAD if:myelocytes or metamyelocytes are seen
|
|
|
viral infection look on CBC with differential:
|
total WBC usually nml, lymphocytes predominate
|
|
|
CSF results in viral infection:
|
nml glucose, lymphocytosis, probably normal protein levels
|
|
|
tx of suspected aseptic / viral meningitis:
|
acyclovir, seek help
|
|
|
tx of suspected septic / bacterial meningitis:
|
ceftriaxone with vancomycin; pending bacterial sensitivity results; seek help
|
|
|
m/c pathogen in CAP in child:
|
virus
|
|
|
most appropriate antimicrobial for CAP in 2y/o:
|
azithromycin
|
|
|
% of children who have pneumonia by age 5?
|
20%
|
|
|
antimicrobial effective agains atypical pathogens of pneumonia?
|
clarithromycin
|
|
|
crawl and creep at how many months?
|
9-11m for crawl and creep
|
|
|
peek a boo and pat a cake at how many months?
|
9-11m for peekaboo and patacake
|
|
|
says mama and dada with meaning at how many months?
|
9-11m
|
|
|
follows simple commands at ___ m/o?
|
9-11m
|
|
|
can run, turn, and balance at what age?
|
4-5y
|
|
|
count to 4 at what age?
|
4-5y "count to 4 at 4"
|
|
|
buttons clothes and dresses self at what age?
|
4-5y
|
|
|
plays without adult input for 30 minutes at what age?
|
4-5y
|
|
|
backbone tx for mild persistent, moderate persistent, or severe persistent asthma
|
inhaled corticosteroid; could mast cell stab. (cromolyn) or LKT modifiers (montelukast, zafirlukast)
|
|
|
effects for corticosteroids or LKT modifiers take place in:
|
1-2w
|
|
|
a LABA example:
|
formoterol, salmeterol
|
|
|
a SABA example:
|
albuterol, levalbuterol (better than the other two: greater bronchodilation at a lower dosage with fewer SE's), pirbuterol
|
|
|
asthma, clarified:
|
a lower airway disease, more problems with expiration - "air trapping"
|
|
|
asthma, findings:
|
decreased PEF, prolonged expiration, thoracic hyperresonance on percussion, hyperinflation seen on xray; O2 desat is a LATE finding
|
|
|
sx onset for food poisoning with Staph:
|
1-4h
|
|
|
sx onset for food poisoning with salmonella:
|
12-24h
|
|
|
% of body weight lost in child with moderate dehydration:
|
6-10%
|
|
|
shigellosis clinical features:
|
bloody diarrhea, high fever, malaise; NOT vomiting
|
|
|
acute gastroenteritis characteristics:
|
<4d, N/V/D, no blood or pus, highly contagious, almost always VIRAL; determine hydration status via "When was the last urination?"
|
|
|
premature thelarche is:
|
early breast development; relatively common
|
|
|
premature andrenarche is:
|
early pubic hair growth
|
|
|
precocious puberty in girls, onset is:
|
<8y
|
|
|
girls achieve all height by:
|
1 year after first menses
|
|
|
precocious puberty in boys, onset is:
|
<9y, refer, as this is most likely a gonadal or adrenal tumor
|
|
|
murmur of ASD is:
|
first found on a 2 to 6 month WC exam
|
|
|
for low-pitched heart sounds, use
|
bell of stethoscope
|
|
|
for high-pitched heart sounds, use
|
diaphragm of stethoscope
|
|
|
body temp. increase from fever causes:
|
lower viral replication rates, toxic effect on certain bacteria, negative effect on S. pneumonia growth
|
|
|
in aseptic / viral meningitis, the CSF will have:
|
predominance of lymphocytes
|
|
|
sepsis, defined:
|
clinical manifestation of systemic infection
|
|
|
febrile seizure occurs at what point in illness?
|
most likely to occur as fever is increasing, rather than at its peak
|
|
|
seizures in first 2y of life?
|
yes, commonly 4-6 acute febrile episodes per year (parents seek health care in 2/3 of cases)
|
|
|
if fever persists, should RTC, when:
|
1-2d; sooner if fever worsens
|
|
|
onset of action of IBU and APAP
|
within 30m
|
|
|
duration of APAP action
|
4h
|
|
|
duration of IBU action
|
6h
|
|
|
antipyretic effects of IBU and APAP at lower grade fevers (<102.5):
|
equivalent
|
|
|
antipyretic effects of IBU and APAP at higher grade fevers (>102.5):
|
IBU has greater antipyretic potential than APAP during higher fevers
|
|
|
used during varicella outbreak for pain and antipyretic effects:
|
APAP, because IBU is implicated in necrotizing fasciitis
|
|
|
if sepsis is suspected, what is empirical antimicrobial tx?
|
IM ceftriaxone at 50mg/kg q 24h + supportive care, need culture and sensitivity
|
|
|
"left shift" causes:
|
severe bacterial infection, appendicitis, pneumonia
|
|
|
bacterial infection look on CBC with differential:
|
leukocytosis, neutrophilia, bandemia; toxic granulation; REALLY BAD if:myelocytes or metamyelocytes are seen
|
|
|
viral infection look on CBC with differential:
|
total WBC usually nml, lymphocytes predominate
|
|
|
CSF results in viral infection:
|
nml glucose, lymphocytosis, probably normal protein levels
|
|
|
tx of suspected aseptic / viral meningitis:
|
acyclovir, seek help
|
|
|
tx of suspected septic / bacterial meningitis:
|
ceftriaxone with vancomycin; pending bacterial sensitivity results; seek help
|
|
|
m/c pathogen in CAP in child:
|
virus
|
|
|
most appropriate antimicrobial for CAP in 2y/o:
|
azithromycin
|
|
|
% of children who have pneumonia by age 5?
|
20%
|
|
|
antimicrobial effective agains atypical pathogens of pneumonia?
|
clarithromycin
|
|
|
crawl and creep at how many months?
|
9-11m for crawl and creep
|
|
|
peek a boo and pat a cake at how many months?
|
9-11m for peekaboo and patacake
|
|
|
says mama and dada with meaning at how many months?
|
9-11m
|
|
|
follows simple commands at ___ m/o?
|
9-11m
|
|
|
can run, turn, and balance at what age?
|
4-5y
|
|
|
count to 4 at what age?
|
4-5y "count to 4 at 4"
|
|
|
buttons clothes and dresses self at what age?
|
4-5y
|
|
|
plays without adult input for 30 minutes at what age?
|
4-5y
|
|
|
backbone tx for mild persistent, moderate persistent, or severe persistent asthma
|
inhaled corticosteroid; could mast cell stab. (cromolyn) or LKT modifiers (montelukast, zafirlukast)
|
|
|
effects for corticosteroids or LKT modifiers take place in:
|
1-2w
|
|
|
a LABA example:
|
formoterol, salmeterol
|
|
|
a SABA example:
|
albuterol, levalbuterol (better than the other two: greater bronchodilation at a lower dosage with fewer SE's), pirbuterol
|
|
|
asthma, clarified:
|
a lower airway disease, more problems with expiration - "air trapping"
|
|
|
asthma, findings:
|
decreased PEF, prolonged expiration, thoracic hyperresonance on percussion, hyperinflation seen on xray; O2 desat is a LATE finding
|
|
|
sx onset for food poisoning with Staph:
|
1-4h
|
|
|
sx onset for food poisoning with salmonella:
|
12-24h
|
|
|
% of body weight lost in child with moderate dehydration:
|
6-10%
|
|
|
shigellosis clinical features:
|
bloody diarrhea, high fever, malaise; NOT vomiting
|
|
|
acute gastroenteritis characteristics:
|
<4d, N/V/D, no blood or pus, highly contagious, almost always VIRAL; determine hydration status via "When was the last urination?"
|
|
|
premature thelarche is:
|
early breast development; relatively common
|
|
|
premature andrenarche is:
|
early pubic hair growth
|
|
|
precocious puberty in girls, onset is:
|
<8y
|
|
|
girls achieve all height by:
|
1 year after first menses
|
|
|
precocious puberty in boys, onset is:
|
<9y, refer, as this is most likely a gonadal or adrenal tumor
|
|
|
murmur of ASD is:
|
first found on a 2 to 6 month WC exam
|
|
|
for low-pitched heart sounds, use
|
bell of stethoscope
|
|
|
for high-pitched heart sounds, use
|
diaphragm of stethoscope
|
|
|
body temp. increase from fever causes:
|
lower viral replication rates, toxic effect on certain bacteria, negative effect on S. pneumonia growth
|
|
|
in aseptic / viral meningitis, the CSF will have:
|
predominance of lymphocytes
|
|
|
sepsis, defined:
|
clinical manifestation of systemic infection
|
|
|
febrile seizure occurs at what point in illness?
|
most likely to occur as fever is increasing, rather than at its peak
|
|
|
seizures in first 2y of life?
|
yes, commonly 4-6 acute febrile episodes per year (parents seek health care in 2/3 of cases)
|
|
|
if fever persists, should RTC, when:
|
1-2d; sooner if fever worsens
|
|
|
onset of action of IBU and APAP
|
within 30m
|
|
|
duration of APAP action
|
4h
|
|
|
duration of IBU action
|
6h
|
|
|
antipyretic effects of IBU and APAP at lower grade fevers (<102.5):
|
equivalent
|
|
|
antipyretic effects of IBU and APAP at higher grade fevers (>102.5):
|
IBU has greater antipyretic potential than APAP during higher fevers
|
|
|
used during varicella outbreak
|
APAP, because IBU is implicated in necrotizing fasciitis
|
|
|
if sepsis is suspected, what is empirical antimicrobial tx?
|
IM ceftriaxone at 50mg/kg q 24h + supportive care, need culture and sensitivity
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"left shift" causes:
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severe bacterial infection, appendicitis, pneumonia
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bacterial infection look on CBC with differential:
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leukocytosis, neutrophilia, bandemia; toxic granulation; REALLY BAD if:myelocytes or metamyelocytes are seen
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viral infection look on CBC with differential:
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total WBC usually nml, lymphocytes predominate
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CSF results in viral infection:
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nml glucose, lymphocytosis, probably normal protein levels
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tx of suspected aseptic / viral meningitis:
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acyclovir, seek help
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tx of suspected septic / bacterial meningitis:
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ceftriaxone with vancomycin; pending bacterial sensitivity results; seek help
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m/c pathogen in CAP in child:
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virus
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most appropriate antimicrobial for CAP in 2y/o:
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azithromycin
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% of children who have pneumonia by age 5?
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20%
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antimicrobial effective agains atypical pathogens of pneumonia?
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clarithromycin
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