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62 Cards in this Set

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primary care provider’s role as part of the team of providers caring for the child
coordinating the further assessment of the child by the team of professionals that is indicated and provide continuity in the care of the child and family
primary care provider’s counseling role
Educating parents about normal and aberrant development and behavior may prevent problems through early detection and anticipatory guidance.... Many parents expect and need specific, detailed advice from the clinician
Educational intervention begins in the home with early stimulation often with the aid of which specialists?
childhood educator, nurse, or occupational/speech/physical therapist
usually part of the overall educational program and is based on the tested language strengths and weaknesses of the child - should also have
speech therapy, hearing testing
nursing or social work involvement with the family. These specialties often have to coordinate other specialty services.
Social and environmental intervention
Medical intervention involves providing primary care and specific treatment of conditions associated with disability. Goal:
minimize functional impairments in the absence of curative treatment (which is often not possible)
vision impairment (we need to make the Dx around age
4-8 mos. based on parental concerns
PCPs need to screen children in infancy for hearing loss which is easy to do using
Auditory Brainstem Response and Otoacoustic Emissions
speech-language impairment: the PCP role is screening based on what test?
Denver II
provide for physical needs, emotional support, educations and socialization.
family
Regardless of family structure, the presence of a loving adult or adults serving as a parent or parents committed to the fulfilling of a child's physical, emotional, and socialization needs is the best predictor of
a child's optimal health and development.
Most common chronic dz of childhood. 1 in 13 school age children. 5 million children younger than 18. More than 5500 fatalities annually.
asthma
air pollution, temperature extremes, high humidity, allergens (like animal dander, molds, pollen), tobacco smoke, URI, exercise, rhinitis/sinusitis, GERD.
Environmental triggers/factors for asthma
PEFR of 80% - 100% of the child's personal best value
Green zone: child is likely asymptomatic and should continue with meds as usual.
PEFR 50% - 80% of the child's personal best value; coincides with more asthma symptoms;
Yellow zone: rescue meds (ie. albuterol) are added; contact primary care provider if PEFRs do not return to green zone within the next 24 to 48 hours OR if asthma symptoms are deteriorating.
PEFR of < 50% of child's best value
MEDICAL EMERGENCY; rescue meds should be taken immediately; if PEFR remains in the red zone or significant airway compromise emergency care is needed and primary care provider called.
most effective anti-inflammatory med for the tx of chronic, persistent asthma; available as metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizer soln; egs. beclomethasone, budesonide, flunisolide, fluticasone, and triamcinolone.
Inhaled Corticosteroids, long
Oral, daily-use asthma meds that are potent mediators of inflammation and smooth muscle bronchoconstriction; zafirlukast is approved for children over 5 years. montelukast comes in granules or chewable tabs for children age 12 mos to 5 years.
Leukotriene Modifiers, long
formoterol
salmeterol;
often combined with inhaled corticosteroid
relax smooth muscle; dosed BID; egs.
Long-Acting Beta2-Agonists, long
not used as much anymore; considered as an alternative add-on tx to inhaled corticosteroids. mild to mod effictive as a bronchodilator; theophyline levels in blood have to be monitored closely and there are many adverse effects associated with this drug.
Theophylline, long
subcutaneous therapy with omalzumab (Xolair) is approved for mod to severe allergic asthma in children 12 yrs and older; it is a humanized anti-IgE monoclonal antibody.
Novel Therapies
albuterol, levalbuterol, and pirbuterol; most effective bronchodilators; work within 5 to 10 minutes and last 4 to 6 hours; usually prescribed for acute symptoms and as prophylaxis before allergen exposure and exercise; MDIs and nebulizers.
Short-Acting Beta2-Agonists, quick
ipratropium bromide
(Atrovent)
relieves bronchoconstriction
decreases mucus hypersecretion
counteracts cough-receptor irritability.

binds acetylcholine
at the
muscarinic receptors in
bronchial smooth muscle;
additive effect with
beta2-agonists
Anticholinergic Agent, quick
short bursts (3 to 10 days) are administered to children with acute asthma exacerbations; liquid or tablets; children with severe asthma may require oral corticosteroids for extended periods
Oral Corticosteroids, quick
Step-wise tx:
Short-acting bronchodilator for all children with asthma, use rule of twos to determine if controller meds needed. reevaluate to step up or step down
used to determine if a child has persistent asthma and needs daily anti-inflammatory meds; Daytime symptoms occurring > 2 times/wk or nighttime awakening > 2 times/month.
Rule of Twos
Susceptibility to DM I is controlled by
alleles of Major Histocompatability Complex (MHC) II that express human leukocyte antigen (HLA).
Genetic predisposition for DM type I is also associated with
celiac disease and thyroiditis
inappropriate polyuria in any child with poor weight gain, dehydration, or "the flu". Hyperglycemia, glycosuria, ketonuria, nonfasting glucose > 200
mmon presentation of undiagnosed DM1
% of children with undiagnosed DM I will present with DKA
20-40
obesity, acanthosis nigricans
Type II Diabetes Mellitus (DM2) in children
impermeability to Cl & excessive reabsorption of Na. dehydration, impaired mucociliary transport and airway obstruction. Most are colonized with H. influenza, S aureus, or P aeruginosa. exocrine pancreatic insufficiency
cystic fibrosis (CF)
symptom in CF that results from maldigestion
steatorrhea
Chronic bronchial infection and sinusitis. Digital clubbing, steatorrhea, meconium ileus, distal intestinal obstruction syndrome, insulin deficiency, allergic bronchopulmonary aspergillosis
complications of CF
lab test that is used to confirm the diagnosis of CF, and diagnostic level
sweat test, >60 mEq
these S/S may interfere with what test?Adult age, adrenal insuff., eczema, ectodermal dysplasia, nephrogenic DI, hypothyroidism, fucosidosis, mucopolysaccharides, dehydration, malnutrition, poor technique,
possible causes for a false negative on cloride sweat test for CF
Clearance techniques, Pharmacologic measures & ABX therapy.
treatment for chest dz in CF.
replace pancreatic enzymes, encourage high calories, vitamins, enzymes to increase absorption. too much lipase may result in intestinal obstruction though.
treatment for pancreatic insufficiency in CF
in newborn may require surgery, may use contrast enemas. In child, use balanced intestinal lavage solution via nasogastric tube or enema. Increase hydration, fiber
treatment for Meconium ileus in CF
tx w/ ursodiol or endoscopic dilation of the ampulla of Vater if stenosis is present.
treatment for Cholestasis in CF
sex-linked recessive trait, 2-3/ 10,000 boys. Absence of dystrophin, a protein that belongs in the muscle fiber plasma membrane
Duchenne muscular dystrophy
autosomal dominant genetic dz caused by progressive expansion of a triplet repeat in a gene designated myotonin protein kinase
myotonic dystrophy
2-3 yo develop awkward gait/run. Hypertrophy of the calf, mild-mod prox leg weakness. Child uses arms to climb up his legs and body (Gower sign). Arm weakness by 6 yo, w/c bound by 12yo. 16yo respiratory and arm weakness.
Duchenne muscular dystrophy
trouble relaxing mm contraction. hypotonia & weakness at birth or slowly progressive facial and distal ext weakness & myotonia at adolescence. arrhythmias, cataracts, male baldness, infertility. ptosis and drooping of lower lip.
myotonic dystrophy
treatment for myotonic dystrophy as well as Duchenne muscular dystrophy
symptomatic
Serum Creatine Phosphokinase levels are always elevated. Muscle Biopsy shows mm fiber degeneration & regeneration accompanied by increased intrafascicular connective tissue. dx by DNA probe.
Duchenne muscular dystrophy
Mat thyroid disorder,
FH mental retardation,
Low SES ,
Maternal seizures,
Eclampsia,
3rd trimester bleeding,
Multiparity,
Fetal growth retardation,
Abnormal presentation,
Congenital malformation,
hypoxic-ischemic or
bilirubin (kernicterus)
encephalopathy
risk factors for CP
Cerebral Palsey
epidemiology of CP
2-2.5 of every 1000 live born children in developed countries
Failure to reach motor milestones, asymmetric gross motor function, increased motor tone floppiness
CP
Results from injury of UMN of pyramidal tract. Occasionally bilateral. 2 of following:
abnormal movement pattern,
increased tone,
pathologic reflexes
(positive Babinski,
Hyperreflexia)
Spastic CP
Abnormal patterns of movement and involuntary, uncontrolled, recurring movements
dyskinetic CP
More than one type of motor pattern is present/one pattern does not clearly dominate another. sensory deficits, seizures, cognitive-perceptual impairments
mixed CP
management of the following diseases related to ??? may help improve educational attainment: Epilepsy, Learning difficulties, behavioral challenges, sensory impairments
CP
unknown etiology. higher risk in siblings compared to general population. males 4x more compared to females
Autism
normal growth rate until 1-2yo. not cuddly, with delayed or absent smiling. Solitary play w/ little to no interest in communication or eye contact. Intense, absorbing interests, ritualistic behavior, and compulsive routines necessary to avoid tantrums.
autism
CNS abnormalities, fragile-x syndrome, tuberous sclerosis, language disorders, Asperger dis., childhood disintegrative dis., Rett syndrome, pervasive developmental disorder not otherwise specified.
ddx for autism
tx is focused on sxs or syndromes. aggression may need atypical antipsychotics, inattention may need ADHD stimulant, self-stimulatory behavior may need naltrexone. Specialist referral necessary
autism tx
diverse, tends to run in some families- but no gene found, seen in children with other brain development disorders (ie fetal alcohol synd., Down synd.). common pathway for diverse causes, including genetic, organic, and environmental etiologies.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Epidemiology of ADHD is what % of school age children? boys how many times higher than girls? 60-80% persist into adolescence, & some sxs into adulthood.
8-10%, two times more likely
in general, the sx are inattention, hyperactivity/impulsivity. What disorder? What quesitionairres are necessary?
Conners Questionnaires and the Vanderbilt.
why do a physical exam when suspecting ADHD?
rule out underlying medical problems
Behavioral Approaches- structure, routine, behavior goals. Stimulant Medication- tricyclic antidepressants, bupropion, methylphenidate, dextroamphetamine & clonidine. This is a tx for what disorder?
ADHD