Term
| What values are charted on a growth chart? |
|
Definition
infants= length, weight, and head circumference
children over 2= hieght, weightand BMI |
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Term
| What components of the psychosocial history should you ask teenagers? |
|
Definition
| home life, education, employment, activities, drugs, depression, safety (seat belts, guns in the home, abuse), sexual activity |
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Term
| How should you examine a pt whom you suspect has epiglotitis? |
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Definition
| don't inspect the pharynx, leave the pt in the parents arm during the physical exam |
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|
Term
| What's the difference between rectal and oral temps? |
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Definition
| rectal is the gold standard; oral is generally 1 degree below rectal |
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Term
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Definition
| anterior fontanelle, open, soft, and flat |
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Term
|
Definition
| cyanosis, clubbing, edema |
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Term
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Definition
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Term
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| normocephalic, atraumatic |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| usual state of good health |
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Term
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Definition
| well developed, well nourished |
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Term
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Definition
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Term
| How should you maneuver the auricle if you want to see the tympanic membrane? |
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Definition
| in an infant, pull the auricle backward and downward; in an older child, pull backward and upward |
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|
Term
| What is the average heart rate of a newborn? |
|
Definition
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|
Term
| Why is it important to check femoral pulses in an infant? |
|
Definition
| to exclude coarctation of the aorta |
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|
Term
| What percent of infants have innocent murmurs? |
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Definition
|
|
Term
| What is a normal heart rate in a child? |
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Definition
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|
Term
| What are characteristics of an innocent murmur? |
|
Definition
| low intensity (I-II/VI), occurence in systole, variation with position and respiration, and a musical quality |
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|
Term
| What is a normal respiratory rate for a newborn? |
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Definition
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|
Term
| What is a normal respiratory rate in a child? |
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Definition
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|
Term
| How is infant breaths different from adult breaths? |
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Definition
| expiration is more prolonged in infants; respiratory movements are produced by abdomenal movements |
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Term
| Describe the Barlow maneuver. |
|
Definition
| stabilize the pelvis with one hand, and then flex and adduct the opposite hip and apply gental posterior pressure on the thigh |
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Term
| What is the name of the maneuver used to dislocate the hip in developmental hip dysplasia? |
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Definition
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|
Term
| What is the maneuver used to reduce a hip dislocation of developmental hip dislocation? |
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Definition
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|
Term
| Describe the ortolani maneuver? |
|
Definition
| place one finger on the greater trochanter and one on the inner thigh, flex and abduct thehip and lift the femoral head anteriorly, feeling for a clunk as it relocates into the acetabulum |
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Term
| When is a pediatrician called to a birth? |
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Definition
| multiple gestations, preterm deliveries, cesarean sections, possible meconium aspirations, and known fetal anomalies |
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Term
| What should be done to a baby who is born? |
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Definition
| dried off, nose and mouth are suctioned, and the baby is rubbed and stimulated and placed under a warmer; apgar scores are assessed at one and five minutes and baby recieves an initial head to toe evaluation |
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Term
| At what age do children get heel sticks? |
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Definition
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|
Term
| Most neonatal reflexes disapear by what age? |
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Definition
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|
Term
| What is the significance of persistent primitive reflex? |
|
Definition
| those infants are at greater risks for developmental disability |
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Term
| At what age should children be crawling? |
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Definition
| crawling is not a developmental milestone because some children skip this step |
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|
Term
| What is a premature baby? |
|
Definition
|
|
Term
| How long do you correct for prematurity for? |
|
Definition
|
|
Term
| What is the definition of failure to thrive? |
|
Definition
| weight below third percentile for age, weight less than 80% of ideal, or falling off the growth curve |
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|
Term
| What are the traditional two categories of causes of FTT? |
|
Definition
| medical (organic) and psychosocial (nonorganic) |
|
|
Term
| What are the gross motor developmental milestones? |
|
Definition
| 1 month=lifts head when prone; 4 months= rolls front to back; 5 months= rolls back to front; 6 month= sits upright; 12 months= walks |
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Term
| What are the fine motor milestones? |
|
Definition
| birth= visually fixes; 1 month= tracks to midline; 2 months= tracks past midline; 6= transfers objects; 12= two finger pincer grasp |
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|
Term
| What are the language developmental milestones? |
|
Definition
| 1 month= alerts to sound; 3 months= coos; 4 months= orients to voice; 6 months= babbles; 9 months= mama, dada-nonspecific; 12 months= mama, dada-specific; 15 months= uses 4 to 6 words |
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Term
| What are the social milestones? |
|
Definition
| 2 months= smile; 4 months= laughs; 6 months= stranger anxiety; 12 months= imitates actions and comes when called; 18 months= may start toliet training |
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Term
| What is the timing of the moro startle? |
|
Definition
| present at birth; disappears by 3 to 6 months |
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|
Term
| Describe the moro startle. |
|
Definition
| head extension leads to extension, adduction, and then abduction of the upper extremities |
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|
Term
| Name some neonatal reflexes. |
|
Definition
| moro startle, palmar grasp, rooting, stepping, asymmetric tonic neck, parachute, galant, and babinski |
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|
Term
| What is the timing of the stepping reflex? |
|
Definition
| present at birth; disappears by 2 to 4 months |
|
|
Term
| Describe the stepping reflex? |
|
Definition
| infants move thier legs in a walking movement when they are held upright and leaning forward |
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|
Term
| When does the asymmetric tonic neck reflex disappear? |
|
Definition
| turning the head while leads to ipsilateral extremity extension and contralateral flexion (fencer position) |
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|
Term
| What is the parachute reflex? |
|
Definition
| infants extend the ipsilateral arm to support the body when tilted to one side while sitting |
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|
Term
| When does the galant reflex disapear? |
|
Definition
|
|
Term
| Describe the galant reflex? |
|
Definition
| stroking theparavertebral region while the infant is prone causes the pelvis to move toward the stimulated side |
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Term
| Describe a brief differential of FTT. |
|
Definition
GI= pyloric stenosis, duodenal atresia, malabsorption, celiacs
infection= HIV, TB, intestinal parasites
chronic disease= CF, BPD, CHD
reduced growth potential= congenital syndromes, skeletal dysplasias |
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|
Term
| What is "falling off the growth curve"? |
|
Definition
| crossing down two major percentile lines on a growth chart |
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Term
| How should you workup failure to thrive? |
|
Definition
| assess psychosocial issues; CBC, electrolytes, creatinine, albumin, protein, UA, and urine culture; if GI symptoms= stool guaiac, culture and O&P; sweat chloride test, assessment of bone age, malabsorption tests (stool pH and reducing substances) |
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Term
| In failure to thrive, in what order to kids fall of their growth charts? |
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Definition
| weight first, then height, then head circumference |
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Term
| What much do babies grow in the first year? |
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Definition
| triple in weight and double in length |
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|
Term
| What is the average birth weight? |
|
Definition
|
|
Term
| How much weight should neonates gain in the first few days of life? |
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Definition
| generally they loose 5-10% of their body weight over the first few days; formula fed babies return to BW by the second week of life, whereas breast-fed babies should return to BW by the third week of life |
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|
Term
| How much weight should babies gain per day? |
|
Definition
| 30 g/day for 3-4 months; 10-20 g/day for 4-12 months |
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|
Term
| At what point should the birth weight double? triple? quadruple? |
|
Definition
| doubles at 4-5 months; triples by one year; and quadruples by two years |
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|
Term
| How much weight should a child gain on average per year? |
|
Definition
| 5 lbs per year from age 2 to puberty |
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|
Term
| What is the average birth length? |
|
Definition
| 50 centimeters (20 inches) |
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|
Term
| What is the average height of a one year old? |
|
Definition
|
|
Term
| What is the average height of a three year old? |
|
Definition
|
|
Term
| What is the average height of a four year old? |
|
Definition
|
|
Term
| When do children triple their birth height? |
|
Definition
|
|
Term
| How much do children grow per yea? |
|
Definition
| 2-3 inches per year from age four to puberty |
|
|
Term
| What is the average birth head circumference? |
|
Definition
|
|
Term
| At what rate should the head circumference enlarge in the first year? |
|
Definition
|
|
Term
| What percent of head growth has occurred by age 2? |
|
Definition
|
|
Term
| What are the contraindications to all types of vaccination? |
|
Definition
| current moderate to severe acute illness; severe allergy to a vaccine component |
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|
Term
| What are the contraindications to influenza vaccine? |
|
Definition
| anaphylactic reaction to eggs, current moderate to severe acute illness |
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|
Term
| What are the CI to MMR vaccination? |
|
Definition
| anaphylactic reaction to gelatin or neomycin (perform prior skin testing); current moderate to severe acute illness; preganancy, immune compromise, or use of high dose steroids |
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Term
| What are the contraindications to IPV vaccination? |
|
Definition
| current moderate to severe acute illness; anaphylactic reaction to neomycin, polymyxin B, or streptomycin (perform prior skin testing); |
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Term
| What are the contraindications to DTaP vaccination? |
|
Definition
| concurrent moderate to severe acute illness; encephalopathy within seven days of prior pertussis vaccination (use DT instead of DTaP) |
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Term
| What are the contraindications for oral polio vaccination? |
|
Definition
| current moderate to severe acute illness; pregnancy, immune compromise, high dose steroids |
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|
Term
| What are the CIs for varicella?? |
|
Definition
| current moderate to severe acute illness; pregnancy, immune compromise or use of high dose steroids |
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|
Term
| What kind of reactions to pertussis vaccines necessitate the use of precaution in administering future vaccines? |
|
Definition
| fever greater than 40.5 (105F), shocklike state, persistent crying for > 3 hrs within the first 48 hours of vaccination, or seizure within three days of vaccination |
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|
Term
| What vaccine is administered at birth? |
|
Definition
|
|
Term
| What vaccine is administered at 2 months? |
|
Definition
|
|
Term
| What vaccines should be administered at 4 months? |
|
Definition
|
|
Term
| What vaccines should be administered at 6 months? |
|
Definition
| HBV, DTaP, Hib, IPV, influenza, PCV |
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|
Term
| What vaccines should be administered at 12-15 months? |
|
Definition
| Hib, influenza, PCV, MMR, varicella, HAV |
|
|
Term
| What are the 15-18 month shots? |
|
Definition
|
|
Term
| What are the two year shots? |
|
Definition
| influenza, HAV, meningococcal |
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|
Term
| What are the 4-6 yoa shots? |
|
Definition
| DTaP, IPV, influenza, MMR, varicella |
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|
Term
| What are the 11 to 12 yoa shots? |
|
Definition
| DTaP, HPV, MCV4, PPV, influenza |
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|
Term
| What are the 13 to 14 yoa shots? |
|
Definition
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|
Term
| What are the 15 yoa shots? |
|
Definition
|
|
Term
| What vaccinations are needed at 16 to 18 yoa? |
|
Definition
|
|
Term
| At what ages are vaccinations needed? |
|
Definition
| birth, 2 months, 4 months, 6 months, 12-15 months, 2 years, 4-6 years, 11-12 years, 13-14 years, 15 years, 16-18 years |
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Term
| At what age can a child first recieve the flu vaccine? |
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Definition
| 6 months for the trivalent inactivated influenza vaccine and five years for the live attenuated vaccine; children less than 9 who are receiving the influenza vaccine for the first time should recieve two doses, separated by > 4 weeks for inactivated and > 6 weeks for live attenuated vaccine |
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|
Term
| How far apart should the HAV vaccine be administered? |
|
Definition
|
|
Term
| What is teh dosing of HPV vaccine? |
|
Definition
| first dose to females 11 to 12 yoa; second dose two months after the first and third dose 6 months after the first dose |
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|
Term
| How long should women breast feed? |
|
Definition
| first six months of life infant should be exclusively breast fed; continuation of breast feeding plus formula/food should be continued for optimal infant nutrition |
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|
Term
| After 6 months of breast feeding why might it be advantageous to start adding supplemental diet? |
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Definition
| because the maternal stores of iron are often depleted by that time and infants may require flouride and iron supplementation |
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|
Term
| What are the benefits of breast feeding? |
|
Definition
| faster mother-infant bonding, decrased risk of eczema and cow's milk protein allergy; decreased risk of serious infections due to the presence of maternal IgA antibodies; decreased risk of breast and ovarian cancer in the mom and faster return to prepregnancy weight |
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|
Term
| When is breast feeding NOT recommended? |
|
Definition
| mother has been infected with HIV or is taking antiretrovirals, mother has active, untreated TB, mother is infected with HTLV I or II, using or dependent on illicit drugs, taking chemo or undergoing radiation |
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|
Term
| All breast fed infants should recieve what supplementation? |
|
Definition
| vitamin D supplementaiton (200 IU) to prevent rickets |
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|
Term
| What is formula made up of? |
|
Definition
| can be soy or cow's milk based; with long chain polyunsaturated fatty acids to promote growth, neurodevelopment and visual acuity; can be supplemented with iron |
|
|
Term
|
Definition
| in the first two months of life babies will eat 2-3 ounces (approximately 10-20 minutes breast feeding) every 2-3 hours |
|
|
Term
| When should new foods be introduced to babies? |
|
Definition
| after six months of age at a rate of one per week to allow for the identification of potential allergies |
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|
Term
| What food should never be fed to infants under 1 yoa? |
|
Definition
| honey; also foods that may lead to choking like nuts, raisens, and hot dogs |
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|
Term
| What foods should be avoided in an infant/toddlers diet to avoid food allergies? |
|
Definition
| avoid cow's milk until 1 yoa, eggs until 2 yoa, and peanuts, tree nuts, and fish until 3 yoa |
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|
Term
| What is the normal progression of puberty in males? |
|
Definition
| testicular enlargement --> penile enlargement --> growth spurt --> pubic hair |
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|
Term
| What is the progression of puberty in females? |
|
Definition
| thlarche --> growth spurt --> pubic hair --> menarche |
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|
Term
| What is considered precocious puberty? |
|
Definition
| 2ndary sexual chars in males less than 9, black girls less than 6, white girls less than 7 |
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|
Term
| At 4 to 6 months, a baby should be eating... |
|
Definition
| iron-fortified single-grain cereal; supplemental water |
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|
Term
| At 6 to 7 months, an infants should be eating... |
|
Definition
| strained fruit, consider flouride supplementation (depends on local water supply) |
|
|
Term
| At seven to eight months you should introduce what into a childs diet? |
|
Definition
|
|
Term
| When can you introduce well chopped meats into an infants diet? |
|
Definition
|
|
Term
| When can you add cheese, egg yolk, and protein rich foods into a childs diet? |
|
Definition
|
|
Term
| When should children starteating soft finger foods? |
|
Definition
|
|
Term
|
Definition
| males= childhood size external genitalia; females= preadolescent; elevation of papilla only; no pubic hair |
|
|
Term
|
Definition
| males= enlargement of testes and scrotum, females= breast buds, elevation of breast and papilla; pubic hair= spares, straight downy hair on labia/penile base |
|
|
Term
| What is tanner stage III? |
|
Definition
| males= enlargement of the penis mainly in length; females= enlargement of the breast and areola, single contour; pubic hair= darker, coarse, curled hair |
|
|
Term
|
Definition
| male= continued penile enlargement, especially in breadth, scrotal skin darkens, rugations are present; females= projection of the aerola and papilla; separate contour (the secondary mound); pubic hair is adult type but limited to the genital area |
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|
Term
|
Definition
| male genitalia is adult sie and shape; female breasts are mature (areola recesses and nipple projects); pubic hair is adult quality and distribution (spread to thighs) |
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|
Term
| Why is it important not to leave formula bottles in the crib overnight? |
|
Definition
| can cause milk bottle tooth caries |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is idiopathic early puberty called? in which gender is it more common? |
|
Definition
| true central (gonadotropin-dependent) precocious puberty; more common in females |
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|
Term
| What is the most common cause of gonadotropin dependent precocious puberty? |
|
Definition
|
|
Term
| How do you workup a patient with precocious puberty secondary to elevated gonadotropin? |
|
Definition
| although this is most commonly idiopathic it is important to get a CT/MRI to rule out CNS pathology as a potentially treatable cause |
|
|
Term
| What is the incidence of congenital heart diesease? |
|
Definition
|
|
Term
| What determines whether a cardiac defect is a cyanotic heart defect or an acyanotic heart defect? |
|
Definition
| cyanotic has right to left shunt; acyanotic is a left to right shunt |
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|
Term
| How do you workup a congenital heart disease? |
|
Definition
| CXR, ECG and an echo; sometimes angiography |
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|
Term
| Name some more common acyanotic heart diseases? |
|
Definition
| PDA, ASD, VSD, and coarctation of the aorta |
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|
Term
| What are the symptoms of acyanotic congenital heart conditions? |
|
Definition
| lesions are often asymptomatic in early childhood but as fetal circulation transitions into adult circulation over the first several weeks of life, left to right shunting increases and symptoms of CHF develop, usually between one and three months; large ASD or VSD may lead to Eisenmenger's dynrome |
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|
Term
| What is eisenmenger's syndrome? |
|
Definition
| when longstanding acyanotic congenital heart conditions eventually result in shunt reversal and pulmonary hypertension |
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|
Term
| What are the major causes of cyanotic heart disease? |
|
Definition
| hypoplastic left heart syndrome, truncus arteriosus, transposition of the great vessels, tricuspid atresia, tetralogy of fallot, total anomalous pulmonary venous return |
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|
Term
| How do cyanotic congenital heart conditions present? |
|
Definition
| typically in the first week of life because they have been dependent on the ductus arteriosus, which typically closes within the first week of life |
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|
Term
| What determines the presentation of tetrology of fallot? |
|
Definition
| the severity of the pulmonary artery stenosis |
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|
Term
| What medication is given to most patients with cyanotic congenital heart conditions? |
|
Definition
| PGE1 to maintain a patent PDA |
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|
Term
| What are diaper rashes commonly secondarily infected with? |
|
Definition
| candida albicans; 80% of diaper rashes lasting more than 4 days is colonized with candida |
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|
Term
| What does a diaper rash due to irritant dermatitis look like? |
|
Definition
| ill-defined erythematous patches or plaques, often with scaling; usually spare the inguinal folds |
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|
Term
| What does a candidal infection look like? |
|
Definition
| well-demarcated, beefy-red erytematous patches surrounded by satellite erythematous papules or pustules; can be found within the inguinal folds |
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|
Term
| How do you diagnose candida infection of a diaper rash? |
|
Definition
| usually clinically but you can scrape a satellite lesion, stain with 10% KOH, and observe psuedohyphae under the microscope |
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|
Term
| How do you treat diaper rash? |
|
Definition
| keep diaper area clean and dry; use barier cream in moist areas; treat candidal infection with topical antifungal agents (nystatin is first line treatment for infants, but clotrimazole is an alternative for older children); severe candidal infections can be treated with low potency topical steroid (e.g. 1% hydrocortisone cream) in conjunction with topical antifungals |
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|
Term
| What is the general pathophys of Reye's syndrome? |
|
Definition
| aspirin causes mitochondrial dysfunction characterized by acute severe encephalopathy along with degenerative liver disease |
|
|
Term
| What is the most common cause of bowel obstruction in the first two years of life? |
|
Definition
|
|
Term
| In what gender is intussusception more common? |
|
Definition
|
|
Term
| What is the most common location for intussusception? |
|
Definition
| when one portion of the bowel telescopes into an adjacent portion; usually proximal to the ileocecal valve |
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|
Term
| What are the risk factors for intussusception? |
|
Definition
| polyps, meckel's diverticulum, adenovirus or rotavirus infection, henoch-shonlein purpura, intestinal lymphoma, celiac disease and CF |
|
|
Term
| Whatis the classic triad of intussuception? |
|
Definition
| intermittent colicky abdominal pain, vomiting, and bloody mucous stools= found in only one third of patients but most will at least have one of the signs |
|
|
Term
| What signs of intussuception are ominous? |
|
Definition
| red "currant jelly" stools, lethargy and fever |
|
|
Term
| What should you think if you feel a "sausage-shaped" abdominal mass on palpation? |
|
Definition
|
|
Term
| How do you workup/treat intussusception? |
|
Definition
| assess and correct any volume or electrolyte abnormalities; AXR/US to establish diagnosis in equivocal cases; air contrast or barium enema is both diagnostic and therapeutic but DO NOT do them if there are peritoneal signs |
|
|
Term
| What should you do if a child has signs of intussusception and peritoneal signs? |
|
Definition
|
|
Term
| What percent of intussusceptions are cured by barium/air enemas? |
|
Definition
|
|
Term
| What virus causes rubeola (measles)? |
|
Definition
|
|
Term
| What are the symptoms of measles (rubeola)? |
|
Definition
| cough, coryza, conjunctivitis for 2 to 3 days; koplike spots that resolve before the appearance of the rash; erythematous maculopapular rash that beings on the head and spreads to the body and fades in the same pattern; high fever is present |
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|
Term
| What are the complications associated with rubeola (measles)? |
|
Definition
| otitis media is very common, encephalitis, pneumonia, subacute sclerosing panencephalitis (rare) |
|
|
Term
| What are the three day measles? |
|
Definition
| german measles or rubella |
|
|
Term
| What virus causes rubella? |
|
Definition
|
|
Term
| What re the symptoms of rubella? |
|
Definition
| prodrome of malaise followed by posterior cervical and suboccipital LAD (adolescents may developtransient polyarthralgias); maculopapular rash that begins on the face and then generalizes resolving in 3-5 days; fever on the first day of the rash only; petechieae on the palate (forschheimer spots) |
|
|
Term
| What are petechiae on the palate called/associated with? |
|
Definition
| forschheimer spots= associated with rubella |
|
|
Term
| What are the complications associated with rubella? |
|
Definition
| devastating results if a fetus is infected during gestation; rarely encephalitis and thrombocytopenia |
|
|
Term
| What diseases are caused by HHV-6 and HHV-7? |
|
Definition
| roseola infantum (exanthem subitum) |
|
|
Term
| What are teh symptoms of roseola infantum (exanthem subitum)? |
|
Definition
| abrupt onset of high temperature (more than 40 C or 104F) for 3 to 5 days but the child does not feel ill; as teh fever drops a maculopapular rash appears on the trunk, spread peripherally and resolvesin 24 hours |
|
|
Term
| What are the complications associated with roseola infantum (exanthem subitum)? |
|
Definition
| rapid temperature increases associated with febrile seizures |
|
|
Term
| How is varicella transmitted? |
|
Definition
| hightlycontagious via respiratory droplets and contactwith lesions until crusted over |
|
|
Term
| What are the symptoms of varicella? |
|
Definition
| prodrome of fever and malaise for one day; pruritic tear drop vesicles on an erythematous base that start on the face and trunk and spread peripheraly; lesions break and crust over in one week with different stages of healing |
|
|
Term
| What are the complications associated with varicella? |
|
Definition
| secondary skin infection is most common but in immunocompromised children or neonates; rarely, fatal disseminated disease may occur= meningoencphalitis, hepatitis, pneumonitis |
|
|
Term
| What exanthem is caused by parvovirus B19? |
|
Definition
| erythema infectiosum (fifth disease) |
|
|
Term
| How is erythema infectiosum (fifth disease) transmitted? |
|
Definition
| epidemics occur in the spring; contagious via respiratory secretions |
|
|
Term
| What are the symptoms of erythema infectiosum? |
|
Definition
| mild flu like illness for 7 to 10 days (but a lot of times kids don't have this) then slapped cheek rash with circumoral pallor; then an erythematous maculopapular rash spreads to the trunk and legs in a lacy-reticular pattern (usuallyu lasts 2 to 3 weeks); low grade or no fever |
|
|
Term
| What are the complication sof erythema infectiosum? |
|
Definition
| aplastic crisis (sickle cell disease and other anemias) fetal anema/hydrops fetalis (in utero infection), arthritis, encephalopathy |
|
|
Term
| What is the virus that causes hand, foot and mouth disease? |
|
Definition
|
|
Term
| How is hand, foot and mouth disease transmitted? |
|
Definition
| contagious by direct contact |
|
|
Term
| What are the symptoms of hand, foot and mouth disease? |
|
Definition
| fever, anorexia and oral pain= prodrome; followed by football-shaped" vesicles with surrounding erythema on the hands and feet and oral ulcerations that resolves in one week; fever present |
|
|
Term
| What should also be in your differential if you suspect intususception? |
|
Definition
| constipation, GI infection Meckels diverticulum, lymhpoma in children >6 yoa, meconium ileus in neonates |
|
|
Term
| What is the male to female ratio of pyloric stenosis? |
|
Definition
|
|
Term
| What is the incidence of pyloric stenosis? |
|
Definition
|
|
Term
| When does pyloric stenosis present? |
|
Definition
| first 2 to 8 weeks of life |
|
|
Term
| What are teh findings on physical exam for pyloric stenosis? |
|
Definition
| olive shaped mass in the peigastric area; gastric peristalsis may be visible |
|
|
Term
| What complication is common with pyloric stenosis? |
|
Definition
| hypochloremic, hypokalemic metabolic alkylosis with dehydration secondary to persistent emesis |
|
|
Term
| What is the differential diagnosis for pyloric stenosis? |
|
Definition
| pylorospasm, overfeeding, gastroenteritis, hiatal hernia, duodenal atresia, esophageal stenosis, malrotation/volvulus, incarcerated hernias, meconium ileus, milk protein allergy, GERD |
|
|
Term
| What antibiotic is associated with pyloric stenosis? |
|
Definition
|
|
Term
| How do you treat pyloric stenosis? |
|
Definition
| NG tube placement; correction of dehydration and electrolyte abnormalities; surgical pyloromyotomy |
|
|
Term
| What are the associated diseases/problems with Down syndrome? |
|
Definition
| cardiac defects (endocardial cushion/septal defects); increased incidence of ALL, alzheimer's disease seen in adulthood; GI anomalies (duodenal atresia, hirschspurng's disease) |
|
|
Term
| What is the incidence of Down syndrome? |
|
Definition
|
|
Term
| What causes down syndrome? |
|
Definition
| 95% are due to maternal nondysjunction; 4% due to unbalanced translocation |
|
|
Term
| What is the life expectancy of Down syndrome? |
|
Definition
|
|
Term
| What are the features/associated anomalies of Edwards' syndrome? |
|
Definition
| severe mental/grwoth retardation, prominent occiput, rocker-bottom feet, low-set ears, horseshoe kidney |
|
|
Term
| What are the features/associated symptoms of Patau's syndrome? |
|
Definition
| severe mental/growth retardation, scalp defects, microencephaly, polycactyly, agenesis of corpus callosum |
|
|
Term
| What is the incidence and male:female of Edward's syndrome? |
|
Definition
| incidence of 1 in 300; male to female ratio of 1:3 |
|
|
Term
| What is the incidence and male: female of Patau's syndrome? |
|
Definition
| incidence of 1 in 5000; 2:3 |
|
|
Term
| What is the most common cause of hospital admissions for sickle cell patients? 2nd most common? |
|
Definition
| vaso-occlusive or pain crisis; acute chest syndrome |
|
|
Term
| Where do vaso-occlusive crises in sickle cell patients occur? |
|
Definition
| hand-foot syndrome (dactylitis), priaprism, avascular necrosis of the femoral head; pain crises typically occur in bones |
|
|
Term
| What is the definition of acute chest syndrome? |
|
Definition
| in sickle cell patients; radiologic appearance of new pulmonary infiltrate and fever; hypoxia may be present but is not required for diagnosis; etiology is often unknown but it can be caused by infection and fat emboli (from bone marrow infarcts) |
|
|
Term
| What is the treatment for sickle cell patients with aplastic anemia? |
|
Definition
| most patients need transfusions for 1 to 2 weeks |
|
|
Term
| At what age is acute splenic sequestration most common? |
|
Definition
| between 6 months and 2 years of age |
|
|
Term
| Do you ever do a splenectomy for patients with acute splenic sequestration? |
|
Definition
| yes; if they have had two or more events of acute splenic sequestration |
|
|
Term
| What organisms are sickle cell patients at greater risk of being infected by? |
|
Definition
| streptococcus pneumoniae, haemophilus influenzae, salmonella, neisseria menigitidis (bc of functional asplenia) |
|
|
Term
| How common is it to have strokes/CVAs in sickle cell patients? |
|
Definition
| 11% have an overt stroke by age 20; silent ifarcts in an additional 22% |
|
|
Term
| What are the symptoms of heterozygotes with sickle cell trait? |
|
Definition
| no manifestations of disease but may show painless hematuria or inability to concentrate urine |
|
|
Term
| What are the complications associated with sickle cell? |
|
Definition
| vaso-occlusive crises, acute chest syndrome, aplastic anemia, hemolytic crisis, acute splenic sequestration, serious infection, CVA, pulmonary artery hypertension, renal papillary necrosis, hematuria, cholelithiasis, retinopathy |
|
|
Term
| What are teh first and second most common organisms responsible for osteomyelitis in a sickle cell patient? |
|
Definition
| salmonella then S. aureus |
|
|
Term
| At what age do patients first show signs of sickle cell? |
|
Definition
| afterfour months of age as fetal hemoglobin decreases |
|
|
Term
| How does sickle cell present? |
|
Definition
| progressive hemolytic anemia that develops after four months of age= pallor, splenomegaly, jaundice, systolic ejection murmur and growth retardation; dactylitis is common at initial presentation |
|
|
Term
| Any sickle cell patient with a temperature >38 C must be evaluated for... |
|
Definition
| bacterial sepsis, septic joints or osteomyelitis |
|
|
Term
| What are triggers for acute decompensation of sickle cell patients? |
|
Definition
| hypoxia, changes in temperature and dehydration |
|
|
Term
| Why is sickledex inappropriate for use in newborns? |
|
Definition
| large amounts of fetal hemoglobin can lead to a false negative result |
|
|
Term
| How do you treat sickle cell pain crises? |
|
Definition
| NSAIDS and/or opiods (morphine or hydromorphone), hydration (1.5 to 2.0x maintenance), and O2 for hypoxia |
|
|
Term
| What is the treatement for acute chest syndrome? |
|
Definition
| BS abx (cepahlosporin + macrolide); O2, fluids, analgesics, incentive spirometry, and exchange transfusion in the presence of hypoxia or if hematocrit is less than 18% |
|
|
Term
| Howdo you treat complications of sickle cell like stroke and priapism? |
|
Definition
| chronic exchange transfusions to keep HbS below 30% |
|
|
Term
| How do you treat sickle cell episodes of aplastic anemia, sequestration, hemolytic crisis? |
|
Definition
|
|
Term
| What is teh median life expectancy of sickle cell patients? |
|
Definition
|
|
Term
| What prophylactic medications should be given to sickle cell patients? |
|
Definition
| oral penicillin VK BID at diagnosis until child is at least five yoa; vaccinate against S pneumoniae, H flu, HBV, influenza, N meningitidis; give folic acid QD (somewhat controversial); retinal exams yearly starting at age eight; hip radiographs starting at age 10; echos for pulmonary artery pressure every other year starting at age 10; hydroxyurea in children over 5yoa with hx of severe complications |
|
|
Term
| What should you do to prophylax sickle cell pts with a history of stroke? |
|
Definition
| place them on chronic exchange transfusion protocols ot prevent future events |
|
|
Term
| What should you give to sickle cell patients with transfusions? |
|
Definition
| deferoxamine (desfereal) or the new oral iron chelator deferasirox (exjade) to prevent hemochromotosis |
|
|
Term
| What are teh most common childhood cancers? |
|
Definition
| 1. leukemia, 2. CNS tumors, 3. lymphoma, 4. neuroblastoma; also STS, Wil'ms and bone |
|
|
Term
| At what age does ALL peak? |
|
Definition
|
|
Term
| What are the signs and symptoms of ALL? |
|
Definition
| lethargy, fever, bone pain, limp orrefusal to bear weight and CNS manifestations (including headache); petechiae, purpura and bleeding from thrombocytopenia, pallor from anemia, LAD, HSM, and testicular swelling |
|
|
Term
| HOw do you work up a child with ALL? |
|
Definition
| peripheral smear to reveal large immature lymphoblasts, bone marrow bx to establish diagnosis as morphology of peripheral blasts may not reflect the true bone marrow morphology; obtain a baseline CMP along with calcium, mg, and phos to define baseline values prior to chemo (to monitor for tumor lysis syndrome); flow cytometry, CXR, LP and CT to screen for metastasis |
|
|
Term
| What two lab values are often elevated in patients with ALL? |
|
Definition
|
|
Term
| What are the typical WBC counts in children with ALL? |
|
Definition
| although SLL is a lymphocyte-proliferative disorder; WBC counts can be low, normal or high |
|
|
Term
| How long do you treat ALL? |
|
Definition
| 2 years for girls and 3 years for boys |
|
|
Term
| What are the three steps of ALL treatment? |
|
Definition
| induction, consolidation, and maintenance |
|
|
Term
| What is involved in the induction phase of ALL treatment? |
|
Definition
| prednisone, vincristine and L-asparaginase |
|
|
Term
| What is involved in the consolidation phase of ALL treatment? |
|
Definition
| intrathecal methotrexate with or without cranial irradiation |
|
|
Term
| What is involved in the maintenance phase of ALL treatment? |
|
Definition
| 6-MP, methotrexate, vincristine |
|
|
Term
| What is tumor lysis syndrome? |
|
Definition
| induction phase of chemo induces rapid killing of tumor cells, releasing cytosol directly into the blood; cells contain high concentrations of K, phos, and DNA and thus hyperkalemia, hyperphosphatemia and increased uric acid results in acute renal failure |
|
|
Term
| What is the treatment for tumor lysis syndrome? |
|
Definition
| fluids, diuretics, allopurinol, alkalinization of urine and reduction of phosphate |
|
|
Term
| What is teh tumor marker common for ALL? |
|
Definition
| common ALL antigen= CALLA |
|
|
Term
| What is teh overall cure rate of Wilm's tumor? |
|
Definition
|
|
Term
| What is Wilm's tumor associated with? |
|
Definition
| family hx of wilm's tumor, Beckwith-Wiedemann syndrome, Denys-Drashsyndrome, WAGR syndrome, and neurofibromatosis |
|
|
Term
| What is Beckwith-Wiedemann syndrome? |
|
Definition
| hemihypertrophy, macroglossia, visceromegally, and embryonal tumors |
|
|
Term
| What is denys-Drash syndrome? |
|
Definition
| nephropathy and genital abnomralities; assoc with wilms |
|
|
Term
|
Definition
| Wilm's tumor, aniridia, genitourinary abnomralities and mental retardation |
|
|
Term
| What is the most common presentation of Wilm's tumor? |
|
Definition
| 85% are diagnosed after incidental discoverty of a painless abdominal mass |
|
|
Term
| What are possible symptoms of Wilms tumor? |
|
Definition
| nausea, emesis, bone pain, weight loss, dysuria, polyuria |
|
|
Term
| What are common PE/lab findings in patients with wilms tumor? |
|
Definition
| abdominal mass, fever, hematuria, hypertension, varicocele |
|
|
Term
| What causes hypertension in kids with WIlms? |
|
Definition
| secretion of renin by tumor cells or compression of renal artery by tumor |
|
|
Term
| How do you workup wilms tumor? |
|
Definition
| Abdominal u/s reveals solid intrarenal mass, CT reveals hematogenous metastasis, CBC, LFTs, BUN/Cr, UA; Cest CT or CXR to screen for metastasis |
|
|
Term
| What percent of patients have metastasis when they are diagnosed with wilms? |
|
Definition
| 10-15% of patients have it |
|
|
Term
| How does wilm's tumor metastasize? |
|
Definition
|
|
Term
| What is the treatment for Wilms? |
|
Definition
| abdominal exploration with tumor excision and nephrectomy, postsurgical chemotherapy with vincristine and dactomycin |
|
|
Term
|
Definition
| tumor of neural crest cells that make up the adrenal medulla nd sympathetic nervous system |
|
|
Term
| What is teh most common malignant tumor of infants? |
|
Definition
|
|
Term
| When does neuroblastoma typically present? |
|
Definition
|
|
Term
| What is neuroblastoma associated with? |
|
Definition
| neurofibromatosis, Hirschsprung's disease, beckwith-Wiedemann syndrome and fetal hydantoin syndrome |
|
|
Term
| What are the symptoms of neuroblastoma? |
|
Definition
| abdominal distension, anorexia, weight loss, malaise, an dmuscular symptoms; firm smooth nontender abdominal or flank mass |
|
|
Term
| What are physical exam findings of neuroblastoma? |
|
Definition
| hypertension (from compression of renal vasculature), fever, pallor and periorbital bruising (raccoon eyes); metastases to the liver, bone and lymph nodes can lead to HSM, leg swelling, bone pain or LAD; a skin rash, watery diarrhea (from secretion of VIP), and opsoclonus/myoclonus (dancing eyes/dancing feet) may also be present |
|
|
Term
| How do you work up neuroblastoma? |
|
Definition
| CT of the abdomen, chest and pelvis, bone scan and bone marrow aspirate; LP; 24 hr urine collection for catecholamines (VMA and HVA) are elevated in 95% of patients; CBC, LFTs, coagulation panel, BUN/Cr |
|
|
Term
| What percent of patients with neuroblastoma have distant metastasis at time of diagnosis? |
|
Definition
|
|
Term
| What is another name for Wilms tumor? |
|
Definition
|
|
Term
| What is the treatment for neuroblastoma? |
|
Definition
| excision of localized tumors; for intermediate to high-risk stages combination chemo and/or adjunctive radiation may be used |
|
|
Term
| What is the definition of JIA? |
|
Definition
| collagen vascular disease that is defined by persistent inflammation in > 1 joint for > 6 weeks in a patient <16 yoa |
|
|
Term
| What is the most common age of onset of JIA? |
|
Definition
|
|
Term
| T/F JIA is more common in girls. |
|
Definition
| true; except for stills disease in which girls=boys |
|
|
Term
| What are the three types of JIA? |
|
Definition
| pauciarticular, polyarticular and systemic |
|
|
Term
| What percent of children with systemic JIA develop macrophage activation syndrome? |
|
Definition
|
|
Term
| What is macrophage activating syndrome? |
|
Definition
| life-threatening illness characterized by sudden-onset fever, pancytopenia, HSM, liver dysfunction, DIC, hypofibrinogenemia, and hypertriglyceridemia |
|
|
Term
| What is the most common type of JIA? |
|
Definition
|
|
Term
| What is pauciarticular JIA? |
|
Definition
| affects four or fewer joins, usually large joints (knees and ankles) |
|
|
Term
| What is teh prognosis of pauciarticular JIA? |
|
Definition
| good, 70% go into remission after several years |
|
|
Term
| What is a serious complication of pauciarticular JIA? |
|
Definition
| chronic asymptomatic uveitis can lead to blindness in young children if not diagnosed by slit-lamp examination; acute onset uveitis is more common in older children |
|
|
Term
| How can you tell if a pauciarticular JIA pt is at higher risk for chronic uveitis? |
|
Definition
|
|
Term
| What is the definition of polyarticular JIA? |
|
Definition
| affects five or more joints, usually large (knees, ankles)and small joints (hand, feet), as well as the TMJ and cervical vertebrae |
|
|
Term
| What is the second most common form of JIA? |
|
Definition
|
|
Term
| RF seropositivity in polyarticular JIA is associated with... |
|
Definition
| ANA+, more severe disease, and older age of onset |
|
|
Term
| What is another name for systemic JIA? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the characteristics of systemic JIA? |
|
Definition
| high, spiking fevers to more than 39.4; a "salmon" colored rash that comes and goes with fever, and an unremiting and severe arthritis; other symptoms include myalgias, LAD, growth retardation, HSM, pericarditis, and pleuritis |
|
|
Term
| What is the prognosis of systemic JIA? |
|
Definition
| complete resolution is rare and 1/2 develop destructive arthritis |
|
|
Term
| What are the serologies of systemic JIA? |
|
Definition
| RF and ANA are both negative |
|
|
Term
| What do the lab results of systemic JIA show? |
|
Definition
| anemia of chronic disease; increased WBC count and increased acute phase reactants (ESR, CRP, platelets) |
|
|
Term
| What do the involved joints of JIA look like? |
|
Definition
| warm with limited ROM but rarely erythematous |
|
|
Term
| HOw do you workup a pt with suspected JIA? |
|
Definition
| CBC, ESR, RF/ANA, radiographs, MRI, synovial fluid analysis |
|
|
Term
| What do radiographs of JIA show? |
|
Definition
| soft tissue swellin, osteopenia, joint space narrowing or bony erosions, |
|
|
Term
| What does synovial fluid analysis of JIA joints show? |
|
Definition
| leukocytosis (5000-30,000 WBCs/mm3) and elevated protein |
|
|
Term
| What drugs are used to treat JIA? |
|
Definition
| most respond to NSAIDS, methotrexate for severe disease, antiTNF therapy (etanercept or infliximab) for refractory polyarticulardisease; intraarticular steroids; systemic steroids for severe systemic disease or severe uveitis, steroid eye drops and dilating agents are administered for most cases of uveitis |
|
|
Term
| What are the nonpharmacologic treatments of JIA? |
|
Definition
| calcium supplements and weight bearing exercise to prevent osteoporosis, stretching and morning baths are helpful for morning stiffness |
|
|
Term
| What is the definition of fever? |
|
Definition
| rectal temp over 38 or more than 100.4 |
|
|
Term
| For fever management of an infant, it is important to narrow youre differential by first determining... |
|
Definition
| the age of the child: <28 days, 28-90 days, and 3- 36 months |
|
|
Term
| T/F Acute otitis media can cause fever. |
|
Definition
|
|
Term
| What does it mean to say a patient is toxic appearing? |
|
Definition
| lethargic, signs of poor perfusion, marked hypoventilation or hyperventilation, or cyanosis |
|
|
Term
| What does it mean to call a child lethargic? |
|
Definition
| altered level of consciousness characterized by poor or absent eye contact or failure of the child to recognize the parents or to interact with the environment |
|
|
Term
| What is a full sepsis workup for infants? |
|
Definition
| LP and CSFculture, gram stain, cells, glucose and protein, and possibly HSV PCR, urine culture and UA; CBC with diff, blood culture and BMP (electrolytes, glucose and BUN/CR) |
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