Peds Test 3

Front 1

What is the difference between fever and hyperthermia?

Back 1

Hyperthermia occurs when normal thermoregulation fails, resulting in an unregulated rise in core temperature.

Front 2

True/False. The newborn displays a decreased inflammatory response to invading organisms.

Back 2

True. The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection (p. 451).

Front 3

True/False. Cellular immunity is present at birth.

Back 3

True (p. 451).

Front 4

True/False. Studies have shown that ibuprofen is superior in reducing fever faster and lasts longer than acetaminophen.

Back 4

True. (p. 461)

Front 5

Sepsis is most common in what age group?

Back 5

Neonates and young infants, due to their immature immune system, inability to localize infections, and lack of IgM which is necessary to protect against bacterial infections. (p. 462)

Front 6

___ is an infection resulting from group A streptococci.

Back 6

Scarlet Fever (p. 465)

Front 7

True/False. A child infected with scarlet fever is no longer contagious 24 hours after the initiation of appropriate antimicrobial therapy.

Back 7

True (p. 465)

Front 8

A 6-year-old patient in a clinic has a fever of 101F, nausea and vomiting, sore throat, and what appears to be a sunburn on his face, trunk, and extremities. Upon palpation, you note it has a sandpapery consistency. What do you suspect he has?
A) CMRSA
B) Diptheria
C) Mumps
D) Scarlet fever

Back 8

D) Scarlet fever (p. 465)

Front 9

This is the treatment of choice for scarlet fever.

Back 9

Penicillin V (p. 465)

Front 10

In ___, a pseudomembrane forms over the pharynx, uvula, tonsils, and soft palate.

Back 10

Diptheria (p. 465)

Front 11

In patients with diptheria, what is your primary concern?
A) Consistent dosing with antipyretics, as they can spike a fever as high as 105F.
B) Strict I&O, as the bacteria responsible can cause glomerulonephritis
C) Airway management, as swallowing may become difficult as the pseudomembrane forms
D) Seizure precautions, as acute CNS infection can result in swelling of the brain and meninges

Back 11

C) Airway management, as swallowing may become difficult as the pseudomembrane forms (p. 466)

Front 12

The highest incidence of pertussis is seen in children younger than how old?

Back 12

1 year of age. Children younger than 6 months of age are at greatest risk for severe disease and death (p. 466)

Front 13

Which form of tetanus is the most common worldwide?

Back 13

Neonatal tetanus

Front 14

___, a contagious disease caused by paramyxovirus, is characterized by fever and parotitis.

Back 14

Mumps (p. 474)

Front 15

Current recommendations include first mumps immunization between ___ and ___ months of age.

Back 15

12 and 15 months of age, followed by a second vaccine between 4 and 6 years of age (p. 474).

Front 16

True/False. Once symptoms of rabies have developed, the prognosis is poor.

Back 16

True. (p. 475)

Front 17

___ is a cell-mediated response to an antigenic substance exposure.

Back 17

Contact dermatitis (p. 890)

Front 18

True/False. A child with poison oak contact dermatitis is not contagious.

Back 18

True. (p. 891). Contact dermatitis is not contagious and does not spread either to other parts of the affected child's skin or to other people. Scratching does not spread the rash, but it may cause skin damage or secondary infection.

Front 19

True/False. Latex or rubber gloves are an effective barrier against offending plants such as poison oak.

Back 19

False. Vinyl gloves are an effective barrier (p. 891).

Front 20

___ is the most severe form of erythema multiforme.

Back 20

Stevens-Johnson syndrome (p. 892). It typically occurs in response to certain medications or to Mycoplasma infection.

Front 21

True/False. Erythema multiforme often resolves on its own.

Back 21

True. (p. 892)

Front 22

Urticaria (hives) is a ___ hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from mast cells.
A) Type I
B) Type II
C) Type III
D) Type IV

Back 22

A) Type I (p. 892)

Front 23

A mother brings her infant into the clinic for thick, greasy yellow scales on his scalp and in his diaper area. You suspect he has:
A) Psoriasis
B) Seborrhea
C) Acne neonatorum
D) Pressure ulcers

Back 23

B) Seborrhea (A.k.a. cradle cap)

Seborrhea is a chronic inflammatory dermatitis that may occur on the skin or scalp. It is thought that seborrhea is an inflammatory reaction to the fungus Pityrosporum ovale and is worsened by sebaceous involvement related to maternal hormones in the infant. (p. 893)

Front 24

Which of the following is an accurate intervention for an infant with cradle cap (select all that apply)?
A) Apply a corticosteroid cream like triamcinolone and cover the infant's head with a shower cap.
B) Wash with lukewarm water and anti-dandruff shampoo (like Head and Shoulders) twice daily until lesions resolve.
C) Apply mineral oil to the scalp, massage it well, then shampoo later.
D) Remove the crusts carefully with tweezers. To reduce infection, apply an antibiotic ointment like Neosporin.

Back 24

B, C. (p. 894)

Front 25

Which of the following indicates a need for further instruction in the mother of a child with psoriasis?
A) Exposure to sunlight may promote healing of the skin.
B) The use of warm towels and oil to soak the plaques will help to remove thick plaques.
C) Tar shampoos and skin preparations may be used topically.
D) Very thick lesions may be debrided with hydrogen peroxide.

Back 25

D. All of the other responses are true. (p. 894)

Front 26

Acne neonatorum occurs as a response to the presence of maternal androgens. and generally appears between ___ and ___ weeks of age, and lasts up to ___ to ___ months.

Back 26

Generally appears between 2-4 weeks of age, and lasts up to 4-6 months. (p. 895)

Front 27

True/False. Girls taking Accutane must be on a pregnancy prevention program.

Back 27

True. Accutane causes defects in fetal development (p. 896)

Front 28

The mortality rate from burns is highest in children younger than ___.

Back 28

6 years of age (p. 897)

Front 29

Which of the following is NOT a criteria for referral of persons to a burn unit?
A) Burns that involve the face, hands, feet, genitalia, or major joints
B) Carbon monoxide poisoning
C) Inhalation injury
D) Electrical burns or chemical burns
E) Partial thickness burns greater than 10% of total body surface area

Back 29

B) Carbon monoxide poisoning (p. 898)

Front 30

In ___ burns, the injury occurs not only to the epidermis, but also to portions of the dermis.
A) Superficial
B) Partial-thickness
C) Deep partial-thickness
D) Full-thickness

Back 30

B) Partial thickness (p. 898)

Front 31

These burns may scar and result in changes in nail and hair appearance as well as sebaceous gland function in the affected area.
A) Superficial
B) Partial-thickness
C) Deep partial-thickness
D) Full-thickness

Back 31

C) Deep partial-thickness (p. 898)

Front 32

A 4-year old girl arrives in the ER the victim of burn injury from deliberate child abuse. Upon assessing the child's wound, you note significant tissue damage and can visualize a portion of charred subcutaneous fat. His aunt, who brought him in after his mother called her in hysterics, asks you whether this will leave a permanent scar. What should you tell her?
A) In these situations, extensive scarring usually results and skin grafting may be required.
B) Though erythema and ischemic blood flow to the injury may occur for several days, vascularization will resume once swelling has depleted.
C) These burns usually heal within about two weeks and carry a minimal risk of scar formation.
D) With effective debridement and subsequent grafting, there is a good chance her niece will have little scarring.

Back 32

A. Full-thickness burns result in significant tissue damage as they extend through the epidermis, dermis, and hypodermis. Extensive scarring results, as hair follicles and swear glands are destroyed. Skin grafting may be necessary. (p. 898)

Front 33

Capillary permeability typically returns to normal between ___ and ___ hours after the burn.

Back 33

48 and 72 hours (p. 898)

Front 34

Which of the following is indicated in taking the health history of a child with a burn (select all that apply)?
A) Whether smoke inhalation occurred
B) Was there an associated fall?
C) When was the last tetanus vaccination?
D) What are the child's current medications?

Back 34

A, B, C, D. (p. 899)

Front 35

Intentional scald injuries usually yield what type of formation?

Back 35

"Stocking" or "glove" distribution when the child's extremity is held under very hot water as punishment. (p. 899)

Front 36

What is the purpose of an EKG in the case of a burn injury?

Back 36

EKG monitoring is important for the child who has suffered an electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. (p. 900)

Front 37

True/False. It is important to administer 100% oxygen via nonrebreather mask or bag-valve mask ventilation to all children with severe burns.

Back 37

True. (p. 901)

Front 38

High levels of carboxyhemoglobin as a result of smoke inhalation may skew the pulse ox readings how?

Back 38

High levels of carboxyhemoglobin as a result of smoke inhalation may contribute to falsely high pulse oximetry readings. (p. 901)

Front 39

Which of the following IV fluids is indicated in a child with a burn injury IN THE FIRST 24 HOURS?
A) NS
B) D5NS
C) D51/2NS
D) LR

Back 39

D) Lactate Ringers (p. 901)

Front 40

Which of the following is NOT indicated in the treatment of burns?
A) Soaking the dressing in tap water before removal of gauze
B) Debridement involving the removal of loose skin and eschar
C) Popping blisters when they impede wound care
D) Scrubbing the wound to remove excess eschar and promote healing

Back 40

D) There is no advantage to scrubbing and only makes the pain more intense.

(p. 902)

Front 41

Most cases of Lyme disease are seen between what months?

Back 41

June and August

Front 42

The incidence of Lyme disease is highest between children ages:

Back 42

5-10

Front 43

This is the drug of choice for Lyme disease for children older than 8 years.

Back 43

Doxycycline. NOTE: Because it can cause permanent discoloration of the teeth, children younger than 8 years should be treated with amoxicillin! (p. 479)

Front 44

___ is the most severe and frequently reported rickettsial illness in the US.

Back 44

Rocky Mountain Spotted Fever

Front 45

A (late/early) sign of RMSF is a rash.

Back 45

Late. The rash often starts as small, pink, macular, nonitchy, blanchable spots on the wrists, forearms, and ankles. (p. 481)

Front 46

A ____ is a parasitic intestinal worm.

Back 46

Helminth (p. 481)

Front 47

What are some possible drugs/treatments for scabies?

Back 47

A scabicide, like permethrin or lindane. (p. 483)

Front 48

When it comes to roundworms, ___ are the major source of infected eggs.

Back 48

Human feces (p. 484)

Front 49

True/False. Contact precautions are necessary for patients with roundworms.

Back 49

False. Standard precautions are sufficient, so long as sanitary disposal of feces is carried out (p. 484).

Front 50

True/False. An ideal treatment for gonorrhea is Floxin or Cipro in patients under 18.

Back 50

FALSE. NO Floxin or Cipro if younger than 18 years or pregnant!!! (p. 488)

Front 51

This test is ideal in diagnosing syphilis.

Back 51

The Darkfield examination and direct fluorescent antibody tests (p. 490).

Front 52

Eye color is often determined by what age in infants?

Back 52

6-12 months of age (p. 553)

Front 53

20/20 vision is usually achieved by the time the child is how old?

Back 53

6-7 years old (p.553)

Front 54

True/False. Warm compresses are indicated in the treatment of conjunctivitis.

Back 54

True. (p.555)

Front 55

The usual minimum age for cochlear implants is how old?

Back 55

12 months. (p.555)

Front 56

Review question! Blue sclerae that persist beyond a few weeks of life may be an indicator of what?

Back 56

Osteogenesis imperfect type I, an inherited connective tissue disorder (p. 554).

Front 57

True/False. Tympanic membrane mobility may be tested with audiometry.

Back 57

False. Tympanic membrane mobility may be tested with pneumatic otoscopy (p. 556).

Front 58

The most common bacterial cause of conjunctivitis is:

Back 58

Staphylococcus aureus (p. 557).

Front 59

In the newborn, the most common causes of conjunctivitis are:
A) Staphylococcus aureus
B) Haemophilus influenzae
C) Chlamydia trachomatis
D) Streptococcus pneumonia

Back 59

C) Chlamydia trachomatis. Also, Neisseria gonorrhoeae is a common cause.

Front 60

Viral conjunctivitis is usually characterized by:
A) Inflammation, purulent discharge, and mild pain
B) Purulent discharge with occasional eyelid edema
C) Mucoid discharge and lymphadenopathy
D) Stringy discharge and itching

Back 60

C) Mucoid discharge and lymphadenopathy (p. 561)

Front 61

True/False. The use of eye drops such as Visine may help with the redness of conjunctivitis.

Back 61

False. Avoid the use of vasoconstricting eye drops such as Visine to rid the eyes of redness. Rebound vasodilation may occur, and with it the redness returns. This leads to repeated frequent use of the drops to keep the eyes from being red but does not treat the actual cause of the redness (p. 562).

Front 62

True/False. Therapeutic management of nasolacrimal duct obstruction involves a “wait-and-see” approach.

Back 62

True. (p. 563)

Front 63

True/False. The majority of cases of nasolacrimal duct stenosis resolve spontaneously by 12 months of age.

Back 63

True. (p. 563)

Front 64

___ is a localized infection of the sebaceous gland of the eyelid follicle, usually caused by a bacterial invasion.

Back 64

Hordeolum (p. 563)

Front 65

___ is a chronic painless infection of the meibomian gland.

Back 65

Chalazion. (p. 563)

Front 66

___ refers to chronic scaling and discharge along the eyelid margin.

Back 66

Blepharitis. (p. 563)

Front 67

Of the following eyelid disorders, which is likely the most painful?
A) Hordeolum
B) Chalazion
C) Stye
D) Blepharitis

Back 67

A) Hordeolum is usually painful. (p. 563)

Front 68

True/False. A hordeolum will usually resolve spontaneously.

Back 68

False. Hordeolum and blepharitis both require antibiotic treatment. A CHALAZION will usually resolve spontaneously. If it does not, it may require minor surgical drainage (p. 564).

Front 69

A 3-year old arrives in the clinic presenting with marked eyelid edema and purplish color of the eyelid, but with unaffected visual acuity and no discharge. What do you suspect?
A) Hordeolum
B) Chalazion
C) Periorbital cellulitis
D) Blepharitis

Back 69

C) Periorbital cellulitis (p. 564)

Front 70

True/False. Patching of the eye with a corneal abrasion is no longer recommended.

Back 70

True. Patching of the eye with a corneal abrasion is no longer recommended, as children are often able to open the eye under the patch, which causes drying of the eye and further irritation, possibly contributing to prolonged recovery from the abrasion (p. 567).

Front 71

Another name for farsightedness is what? What about nearsightedness?

Back 71

Hyperopia; myopia. (p. 568)

Front 72

Laser surgery for vision correction is not recommended by the American Academy of Opthamology until how old?

Back 72

21 years old (p. 568), because of the continuing refractive development in the child’s vision through adolescence.

Front 73

___ refers to the misalignment of the eyes.

Back 73

Strabismus (p. 570)

Front 74

Review question! Most children have strabismus intermittently, but this usually resolves by how old?

Back 74

3-6 months of age. Intermittent strabismus that persists past 6 months of age or constant strabismus at any age warrants referral to an ophthalmologist for further evaluation (p. 570).

Front 75

___ refers to poor visual development in the otherwise structurally normal eye.

Back 75

Amblyopia (p. 570).

Front 76

Which of the following is an accurate treatment for amblyopia (select all that apply)?
A) Patching for several hours per day
B) Putting atropine drops in the weaker eye
C) Vision therapy
D) Eye muscle surgery

Back 76

A, C, D. Treatment involves using atropine drops in the BETTER eye (once daily). (p.570)

Front 77

True/False. As with adult glaucoma, therapeutic management of infantile glaucoma is focused on medical management.

Back 77

False. Unlike adult glaucoma, in which medical management is the first step, therapeutic management of infantile glaucoma is focused on surgical intervention (p. 571).

Front 78

True/False. In a child with a congenital cataract, the red reflex will not be observed in the affected eye.

Back 78

True (p. 571).

Front 79

True/False. Breastfed infants have a higher incidence of acute otitis media than formula-fed infants.

Back 79

False. The reverse in true, and breast milk’s immunologic benefits are well known (p. 577).

Front 80

___ refers to the presence of fluid within the middle ear space, without signs or symptoms of infection.

Back 80

___ refers to the presence of fluid within the middle ear space, without signs or symptoms of infection.

Front 81

Evaluation of hearing is recommended when OME lasts ___ or more if language delay, hearing loss, or a learning problem is suspected.

Back 81

3 months or more (p. 578).

Front 82

This type of hearing loss results when transmission of sound through the middle ear is disrupted, as in the case of OME.

Back 82

Conductive hearing loss (p. 580)

Front 83

This type of hearing loss is caused by damage to the hair cells in the cochlea or along the auditory pathway.

Back 83

Sensorineural hearing loss (p. 580)

Front 84

Common signs and symptoms reported that may indicate hearing loss include: When the infant does not turn to sound by ___ months of age; when he does not babble by ___ months of age; when he does not speak by ___ years of age.

Back 84

4; 6; 2 years (p. 581)

Front 85

Myelinatization is usually complete by how old?

Back 85

2 years of age (p. 795)

Front 86

True/False. Deep tendon reflexes are present at birth.

Back 86

True. (p. 795)

Front 87

True/False. Sebaceous glands are present at birth.

Back 87

True. (p. 877)

Front 88

True/False. Cellulitis is usually preceded by skin trauma.

Back 88

True. (p. 884)

Front 89

Which of the following is accurate with regard to home burn care?
A) Applying ice to superficial burns promotes vasoconstriction and decreases edema and the possibility of blistering
B) The application of butter or cream promotes lipid formation and skin hydration, reducing healing time
C) Acetaminophen or ibuprofen are the most useful in the treatment of pain or inflammation
D) Breaking blisters and covering with a loose adhesive bandage like Band-Aid is the most effective treatment for second-degree (partial-thickness) burns.

Back 89

C. (p. 905)

Front 90

Which of the following is NOT true about a child's skin?
A) Skin thickness and characteristics reach adult levels around age 12-13.
B) The infant's epidermis is thinner and loses heat more easily
C) Increased water content of the skin puts the infant at increased risk of blister development
D) Children with dark skin tend to have more pronounced cutaneous reactions than children with lighter skin

Back 90

A. The child's skin thickness and characteristics reach adults levels in LATE teenage years. (p. 907)

Front 91

Without looking at the back of this card, what is the difference between a genotype and phenotype?

Back 91

Genotype is the specific genetic makeup of an individual. It is internally coded inheritable information and refers to the particular allele.

The phenotype is the outward characteristic of the individual.

Front 92

Offspring of an affected parent with an autosome dominant gene will have a ___% chance of inheriting two normal genes (disorder-free).

Back 92

50% chance (p. 1064)

Front 93

Name four common types of genetic disorders that follow the autosomal dominant pattern of inheritance.

Back 93

Nancy Has A Point

Neurofibromatosis
Huntington's Disease
Achondroplasia
Polycystic kidney disease

(p. 1064)

Front 94

Both Bob and Phyllis are carriers of Tay-Sachs disease, an autosomal recessive inheritance. What is the percent chance that their offspring will inherit 2 normal genes? What is the chance they will inherit one normal gene and one abnormal gene (carrier)? What is the chance they will inherit the disorder?

Back 94

25%; 50%; 25% (p. 1065)

Front 95

Why is a man more likely to exhibit an X-linked inheritance disorder?

Back 95

A male has only one X chromosome and, therefore, all the genes on his X chromosome will be expressed (the Y chromosome carries no normal allele to compensate for the altered gene). (p. 1065)

Front 96

True/False. There is no male-to-male transmission of X-linked recessive inheritance.

Back 96

True, since no X chromosome from the male is transmitted to male offspring. (p. 1065)

Front 97

Hemophilia, color blindness, and Duchenne muscular dystrophy are all examples of:
A) Autosomal dominant disorders
B) Autosomal recessive disorders
C) X-linked dominant disorders
D) X-linked recessive disorders

Back 97

D) X-linked recessive disorders (p. 1065)

Front 98

True/False. X-linked dominant disorders are more severe in males.

Back 98

True. In females, even though the gene is dominant, having a second normal X gene offsets the effects of the dominant gene to some extent, resulting in decreasing severity of the disorder. (p. 1066)

Front 99

Hypophosphatemic (vitamin D-resistant) rickets and fragile X syndrome are examples of:
A) Autosomal dominant disorders
B) Autosomal recessive disorders
C) X-linked dominant disorders
D) X-linked recessive disorders

Back 99

C) X-linked dominant disorders (p. 1066)

These disorders are rare.

Front 100

True/False. Spina bifida is considered an autosomal dominant disorder.

Back 100

False. Many of the common congenital malformations, such as cleft lip, cleft palate, spina bifida, pyloric stenosis, clubfoot, congenital hip dysplasia, and cardiac defects are attributed to multifactorial inheritance. (p. 1066)

Front 101

True/False. Mitochondria are inherited almost exclusively from the father.

Back 101

False. Mitochondria are inherited almost exclusively from the mother. (p. 1066)

Front 102

This is a nontraditional inheritance pattern by which the expression of a gene is determined by its parental origin. In this pattern, both the maternal and paternal alleles are present, but only one is expressed; the other is inactive.

Back 102

Genomic imprinting (p. 1067)

Note: Genomic imprinting does not alter the genetic sequence itself, but affects the phenotype observed.

Front 103

True/False. All fetuses that contain monosomies abort in early pregnancy.

Back 103

True. (p. 1067)

Front 104

Which of the following pairs is incorrect?
A) Triple/Quad screening --> Down syndrome, Trisomy 18
B) Amniocentesis --> chromosomal/genetic abnormalities
C) Chorionic villi sampling (CVS) --> Neural tube defects
D) Ultrasound --> structural malformations

Back 104

C. CVS cannot detect alpha-fetoprotein levels; therefore, does NOT detect neural tube defects (p. 1073)

Front 105

You are caring for a newborn who received no antepartum treatment or screening. Upon assessment, you note the infant is particularly "floppy." Knowing what you know about congenital and chromosomal abnormalities, what condition should you begin checking for other indications of?

Back 105

Down syndrome (p. 1084)

Front 106

An infant arrives in the clinic for immunizations, and you note a prominent occiput, low-set ears, severe hypotonia, and hypoplasia of fingernails. Without looking at his chart, what do you suspect he has?
A) Down syndrome (Trisomy 21)
B) Edwards syndrome (Trisomy 18)
C) Patau syndrome (Trisomy 13)
D) Turney syndrome

Back 106

B) Edwards syndrome (Trisomy 18) (p. 1087)

Front 107

True/False. Turner syndrome affects females only.

Back 107

True. Turner syndrome is a common abnormality of the sex chromosome, and the phenotype is female. (p. 1087)

Front 108

Webbed neck is a characteristic sign of ___.

Back 108

Turner syndrome (p. 1088)

Front 109

____ is the most common sex chromosomal abnormality.

Back 109

Klinefelter syndrome.

Front 110

Turner and Klinefelter syndrome are considered:
A) Monosomies
B) Sex chromosomal abnormalities
C) Autosomal dominant
D) Autosomal recessive

Back 110

B) Both are sex chromosomal abnormalities (p. 1088-1089)

Front 111

This is the most common inherited cause of intellectual disability.

Back 111

Fragile X syndrome (p. 1089)

Front 112

These are the hallmark of neurofibromatosis.

Back 112

Cafe au lait spots. (p. 1092)

Note: If more than SIX cafe-au-lait spots are present, neurofibromatosis should be suspected.

Front 113

This is a neurologic disorder in which the child cannot organize sensory input used in daily living.

Back 113

Sensory processing disorder (p. 1112)

Front 114

If a child cannot speak in sentences by ___ months of age, does not have understandable speech 50% of the time by ___ years, cannot sit still for a short story by ___ years, or cannot tie shoes, cut, button, or hop by ___ years, refer the child to be evaluated with a learning disability.

Back 114

30 months; 3 years; 3-5 years; 5-6 years (p. 1112)

Front 115

Intellectual disability is generally organized according to severity.

Mild: IQ ___ to ___.
Moderate: ___ to ____
Severe: ____ to ____.
Profound: ____ to ____.

Back 115

Mild: IQ 50-70
Moderate: IQ 35-50
Severe: IQ 20-35
Profound: IQ less than 20

(p. 1113)

Front 116

The (ICF/ECF) contains 2/3 of our body water.

Back 116

ICF (slide 3, Fluid and Electrolytes ppt.)

Front 117

The sodium-potassium pump is considered (vesicular transport/active transport).

Back 117

Active transport

Front 118

A child on mechanical ventilation is going to have (greater/fewer) fluid requirements.

Back 118

Fewer. (slide 13, Fluid and Electrolytes ppt.)

Front 119

Explain the formula for administering IV fluids to an infant or child.

Back 119

100 mL/kg body weight for the first 10 kg; 50 mL/kg of body weight for the next 10 kg; 20 mL/kg of body weight for the remainder of body weight in kg.

This is the MINIMUM baseline requirement for children.

Front 120

A child weighs 7.4 kg. How much IV fluid should you administer over 24 hrs?

Back 120

30.8 or 31 mL/hr (p. 390)

Front 121

A child weighs 16 kg. How much IV fluid should you administer over 24 hrs?

Back 121

54 mL/hr (p. 390)

Front 122

A child weighs 30 kg. How much IV fluid should you administer over 24 hrs?

Back 122

71 mL/hr (p. 390)

Front 123

Review question! D5W acts as an (isotonic/hypertonic/hypotonic) solution inside the body.

Back 123

HYPOTONIC!

Front 124

With regard to fluid and electrolyte balance, mottled appearance and head-bobbing are ominous signs of WHAT?

Back 124

Shock! (slide 25, Fluid and Electrolyte PPT)

Front 125

Over-excitability, nervousness, tingling sensation, tetany, and seizures are all signs/symptoms of what?

Back 125

These are all indicators of CNS involvement in ALKALOSIS. (slide 29, Fluid and Electrolyte PPT)

Front 126

Lethargy, diminished mental capacity, delirium, stupor, and coma are all signs/symptoms of what?

Back 126

These are all indicators of CNS involvement in ACIDOSIS. (slide 28, Fluid and Electrolyte PPT)

Front 127

True/False. A child will often exhibit normal BP when going through shock.

Back 127

True. Hypotension is a LATE sign of shock. (slide 33, Fluid and Electrolytes PPT)

Front 128

True/False. The rule of nines is not recommended for small children.

Back 128

True. The rule of nines is not recommended in small children because there is a high margin of error. (slide 46, F&E ppt, panopto).

Front 129

The child's hand accounts for ___% of the body surface area.

Back 129

1%

Front 130

True/False. Fluid resuscitation begins at the time the child arrives in the ER.

Back 130

FALSE! Resuscitation begins at the time of injury, not at the time the pt arrives in the ER! Fluid adjustments may need to “catch up” the time between injury & the time when actual resuscitation begins.
(slide 53, F&E ppt)

Front 131

Which of the following is NOT indicated in the first 24 hours of severe burn?
A) Crystalloid solution like LR
B) Colloid suspension
C) Infection control
D) Pain relief

Back 131

B) Colloids are NOT advised in the first 24 hours, because there is a capillary leak going on. If colloids are administered, they are just going to weep it out into their wound, and the wound will swell more.

Note: Never give pain medication before you have started fluid resuscitation!

Front 132

How much LR are children given in the first 24 hrs? (What is the formula?)

Back 132

4 ml X KG X %TBSA burned + maintenance fluid

Note: Give 1/2 this number in the first 8 hours.

(slide 54, F&E ppt)

Front 133

True/False. It is important to premedicate burn injury patients before fluid resuscitation has begun.

Back 133

FALSE!

Front 134

What is the gold standard for monitoring volume status in burn patients?

Back 134

Urine output! (1cc/kg/hr)

Front 135

Remind me. What is the difference between MCV and MCHC?

Back 135

MCV: Average size of the RBC (Normocytic, microcytic, macrocytic)
MCHC: A calculated value that reflects the concentration of Hgb inside the RBC (Normochromic, hypochromic)

Front 136

For what reason would you give a child packed red blood cells? Whole blood? Plasma?

Back 136

PRBCs: Severe anemia, thalassemia, sickle cell disease
Whole blood: Acute hemorrhage or trauma
Fresh-frozen plasma: Hemophilia

Front 137

What is the treatment for iron toxicity? (This is a review question!)

Back 137

Deferoxamine! (YAY, PHARM!)

Front 138

Remember “pink kool-aid syndrome”? When the Hgb is diluted in the cell, which of the following words would you associate with it?
A) Polycythemia
B) Microcytic
C) Hypochromic
D) Normochromic

Back 138

C) Hypochromic
Note: This is associated with MCHC!

Front 139

Which of the following is NOT associated with iron deficiency anemia?
A) Lack of iron supplementation after age 6 months in breastfed infants
B) Overuse of antacids
C) Excessive weight loss
D) Cow’s milk consumption before 12 months of age
E) Low socioeconomic status

Back 139

C) Excessive weight loss. Excessive weight GAIN is a risk factor for iron-deficiency anemia. (p. 923)

Front 140

“Spooning” of the nails is associated with what condition?

Back 140

Iron-deficiency anemia.

Front 141

Which of the following indicates a need for further instruction in the mother of a child with pernicious anemia?
A) As long as action is taken to address the anemia, you won’t call children’s services.
B) Pernicious anemia is caused by a lack of intrinsic factor.
C) My child will need monthly injections of Vitamin B12 until puberty.
D) If left untreated, this condition can lead to exhaustion and memory loss.

Back 141

C) My child will need monthly injections of Vitamin B12 until puberty.
Inform the parent that injections will be required throughout the child’s life. (p. 925)

Front 142

Lead poisoning can lead to:
A) Hypochromic, microcytic anemia
B) Hyperchromic, macrocytic anemia
C) Normochromic, microcytic anemia
D) Normochromic, macrocytic anemia

Back 142

A) Hypochromic, microcytic anemia (p. 925)

Front 143

PATHO REVIEW QUESTION! What is TICS?

Back 143

TICS is a good way to remember microcytic anemia. Remember:
Thalassemia Syndrome
Iron deficiency anemia
Anemia of Chronic Inflammation
Sideroblastic anemia

Front 144

PATHO REVIEW QUESTION! What is a good way to remember macrocytic anemias?

Back 144

BIG FAT RED CELLS!
B-Vitamin B12 or Cobalamin Deficiency
I - Inherited - Rare disorders such as orotic aciduria, Lesch- Nyhan syndrome
G-Gastroentestinal disease or surgery
F-Folic Acid Deficiency
A-Alcoholism
T-Thiamine responsive
R - Reticulocytes- Reticulocytes are larger than the mature red cell and may inflate the MCV
E- Endocrine - Hypothyroidism
D-Dietary - Lack of dietary folate, B12, protein, or lipids may contribute to the megaloblastic anemia.
C - Chemotherapeutic Drugs
E-Erythroleukemia
L- Liver Disease
L- Lesch-Nyhan Syndrome
S-Splenectomy

Front 145

This type of anemia is characterized by the failure of the bone marrow to produce cells.

Back 145

Aplastic anemia

Front 146

True/False. Infants with sickle cell anemia are usually asymptomatic until 3-4 months of age.

Back 146

True. They are asymptomatic until 3-4 months of age because Hgb F protects against sickling. (p. 927)

Front 147

Why might sickle cell children have an increased incidence of enuresis?

Back 147

Kidneys cannot concentrate urine effectively. (p. 928)

Front 148

Which of the following might you note in a child with sickle cell anemia (select all that apply)?
A) Erythema and petechiae on the conjunctiva and gums
B) Scleral icterus
C) Jaundice of the skin
D) Pallor of the skin, palms, and soles
E) Hypothermia and bradycardia

Back 148

B, C, D. (p. 929-930)

Front 149

You have just arrived at the clinic for the day shift and are assessing your patients. Which of the following patients is considered emergent (which should you focus on first)?
A) 11 month old with swelling of the hands and feet and history of sickle cell disease
B) 14 year old, arriving for her Vitamin B12 injection, complaining of weakness and lightheadedness.
C) A 2-year-old in for possible lead poisoning whose serum values came back at 18 mcg/dL.
D) A 13-year-old hemophilic patient who is 20 minutes late on his infusion of Factor IX.

Back 149

A. (See p. 930). Immediately report symmetric swelling of the hands and feet in the infant or toddler. Termed dactylitis, aseptic infarction occurs in the metacarpals and metatarsals. Occurrence before age 1 year is predictive of severity of illness.

Front 150

Arrange the following cases in order of most emergent to least emergent:
A) A 2-year old with partial-thickness burn to his foot and ankle whose blister popped overnight.
B) A 6-year-old African American girl complaining of thirst and extreme pain in her joints
C) A 13-year-old hemophiliac boy with significant swelling and discoloration of the knee
D) A screaming 3-year-old diagnosed with Fragile X syndrome

Back 150

B, C, A, D. (A and C are negotiable.)

Front 151

Which of the following pain medications should you avoid in a child undergoing a sickle cell crisis?
A) Advil (Ibuprofen)
B) Meperidine (Demerol)
C) Norco (Acetaminophen plus Codeine)
D) Hydromorphone (Dilaudid)

Back 151

B) Avoid repeated use of Meperidine (Demerol) for pain management during sickle cell crises because it has been associated with an increased risk of seizures when used in children with sickle cell anemia (p. 932).

Front 152

A 1-year-old child arrives in the clinic accompanied by her mother. She has a history of FTT, and the mother states she has always been “paler than other babies.” Upon assessment, you note a prominent forehead and yellowing of the sclerae. What do you suspect?
A) Iron-deficiency anemia
B) Pernicious anemia
C) Sickle cell disease
D) Thalassemia

Back 152

D) Thalassemia is characterized by pallor, jaundice, failure to thrive, hepatosplenomegaly, and jaundice. Iron overload related to thalassemia leads to bony changes such as frontal bossing and maxillary prominence. (p. 934)

Front 153

What is the only FDA approved preventative treatment for contact dermatitis related to poison ivy, oak, or sumac.

Back 153

Ivy Block (p. 892)

Front 154

Hemophilia Type A is a (factor VIII/factor IX) deficiency.

Back 154

Factor VIII (p. 936)

Front 155

Henoch-Schonlein Purpura is a condition that, in children, develops in association with what?

Back 155

A viral or bacterial infection (p. 937). In adults, the condition is usually caused by drugs or toxins.

Front 156

Which disorder is caused by the deficiency of the “glue” that adheres platelets to sites of injury?

Back 156

Von Willebrand disease. Von Willebrand factor serves two functions: to bind with factor VIII, protecting it from breakdown, and to serve as the “glue” that attaches platelets to the site of injury. Deficiency in this factor results in a mild bleeding disorder (p. 941).

Front 157

What is the purpose of Desmopressin in the treatment of vWD or hemophilia?

Back 157

Demospressin may be used to release the factors necessary for clotting. Desmopressin raises the plasma level from stores in the endothelium of blood vessels; this releases factor VIII and vWF from these stores into the bloodstream (p. 941).

Front 158

True/False. The majority of hearing impaired children have two normal hearing parents.

Back 158

True (slide 8, Hearing Presentation ppt.)

Front 159

When is the critical period for hearing development?

Back 159

Birth-3.5 years (this is the time of maximal plasticity). (Slide 18, Hearing ppt.)

Front 160

The ear is fully formed at ___ weeks.

Back 160

24 weeks (slide 19, Hearing ppt).

Front 161

A 6-month old child will most likely exhibit which of the following developmental milestones?
A) Looks at family members and common objects when named
B) Repeats a sound when the adult echoes the child
C) Follows simple commands
D) Says “uh-oh” or “ow,” or “mama/dada”

Back 161

B) Repeats a sound when the adult echoes the child (slide 21, Hearing ppt)

Front 162

What is the gold standard for measuring auditory sensitivity?

Back 162

Audiogram (slide 32, Hearing ppt)

Front 163

In (conductive/sensorineural) hearing loss, hair cells in the cochlea are damaged or diminished in number.

Back 163

Sensorineural. Note: 90% of hearing loss is sensorineural! (slide 40, Hearing ppt).

Front 164

Medical guidelines indicate that all infants should be screened no later than how old?

Back 164

No later than ONE MONTH OLD. (slide 49, Hearing ppt.)

Front 165

Hearing loss should be diagnosed by how old?

Back 165

3 months old (slide 49, Hearing ppt).

Front 166

Amplification (hearing aids) should be fit by how old?

Back 166

By 6 months old, or within 1 month of diagnosis. (slide 49, Hearing ppt)

Front 167

This type of testing involves a head-turn response reinforced with light-up, mechanical toy or short cartoon on a TV.

Back 167

Visual Reinforcement Audiometry (usually done 8 months-2.5 years). (slide 57, Hearing ppt)

Front 168

Bone-anchored hearing systems are usually used at age ___, when the thickness of the skull is appropriate.

Back 168

5-7 years old. (slide 71, Hearing ppt)
Note: Bone anchored hearing systems can also be used in single-sided deafness, as the vibration will transmit over to the other ear.

Front 169

Cochlear implants are usually reserved for children age ___ and older.

Back 169

12 months (slide 75, Hearing ppt)

Front 170

True/False. A cochlear implant is not a cure for hearing loss.

Back 170

True. (slide 82, Hearing ppt)

Front 171

True/False. Persistent strabismus should be evaluated if it persists beyond 6 months of age.

Back 171

False. Persistent strabismus should be evaluated at ANY TIME! (slide 2, Disorder of the Eyes or Ears ppt).

Front 172

Which of the following drugs are known to cause ototoxicity (select all that apply)?
A) Vancomycin
B) Lasix
C) Aminoglycosides
D) Betamethasone
E) Digoxin

Back 172

A, B, C.

Front 173

These are the most common cause of visual difficulties in children.

Back 173

Refractive errors (slide 16, Disorder of the Eyes or Ears ppt)

Front 174

Difficulty with writing, spelling, and composition is called:
A) Dyslexia
B) Dyscalculia
C) Dysgraphia
D) Dyspraxia

Back 174

C) Dysgraphia

Front 175

Problems with manual dexterity and coordination is called:
A) Dyslexia
B) Dyscalculia
C) Dysgraphia
D) Dyspraxia

Back 175

D) Dyspraxia

Front 176

Difficulty with writing, reading, and spelling is called:
A) Dyslexia
B) Dyscalculia
C) Dysgraphia
D) Dyspraxia

Back 176

A) Dyslexia

Front 177

Signs that might indicate a learning disability include the inability to phrase sentences by ___ years, the inability to use speech that is understandable at least 50% of the time by ___ years, the inability to tie shoes, hop, or cut scissors by ___, and the inability to sit for a short story by ___ to ___ years.

Back 177

Signs that might indicate a learning disability include the inability to phrase sentences by 2.5 years, the inability to use speech that is understandable at least 50% of the time by 3 years, the inability to tie shoes, hop, or cut scissors by kindergarten, and the inability to sit for a short story by 3 to 5 years. (slide 5, Cognitive or Mental ppt)

Front 178

Warning signs of autism include not babbling by ___ months, not pointing or using gestures by ___ months, not using single words by ___ months, no two-word utterances by ___ months, or losing language or social skills at any age.

Back 178

Warning signs of autism include not babbling by 12 months, not pointing or using gestures by 12 months, not using single words by 16 months, no two-word utterances by 24 months, or losing language or social skills at any age. (slide 11, Cognitive or Mental ppt)

Front 179

Which of the following is not recommended in treating ADHD patients?
A) The use of “drug holidays”
B) Administering meds after meals
C) Administering only on school days or when needed
D) Monitor for seizure activity

Back 179

D) Psychostimulants are not known to be associated with seizure activity.

Front 180

Which of the following are clinical manifestations of childhood schizophrenia (select all that apply)?
A) Expressive aphasia
B) Rocking and arm-flapping
C) Manic and depressive states
D) Anxiety
E) Motor or vocal tics in times of stress

Back 180

A, B, D.

Front 181

What is the process of regurgitation and swallowing that regurge called?

Back 181

Rumination. Occurs mostly in infants.

Front 182

Pica is most commonly associated with what age group?

Back 182

Toddlers