Development Flashcards

Question

- Independent steps (lower leg/foot control) - Mature pincer grasp - Shows objects to share interest - At least 1 single word. Use mama and dada specifically - Protoimperative pointing (gestures/pointing to an object to obtain) - 1 step command with gestures. Responds to own name.

Answer 1

1yo - Independent steps (lower leg/foot control) - Mature pincer grasp - Shows objects to share interest - At least 1 single word. Use mama and dada specifically - Protoimperative pointing (gestures/pointing to an object to obtain) - 1 step command with gestures. Responds to own name.

Answer 2

14mo - protodeclarative pointing (point to express interest)

Answer 3

18mo (rule of halves) - Runs well - Uses 10-25 words (18 is halfway between 10-25) - Between words and sentences - Points to 3 body parts (cutting the 8 in half to make 3) - Uses cup well. Begins to use spoon - Stacks 4 blocks (half of 8 Is 4) - to get an approx estimate of the number of blocks a child should stack, multiple age in years x 3 and round to the nearest even number) - Hand dominance prior to 18mo is abnormal and “red flag”

Answer 4

2yo - 2 Words sentences, Follows 2-step commands, 50 words, 50% understandable. 6 cubes. identifies 6 body parts. - Steps with both feet on each step, jumps with 2 feet, kick ball, throw overhand, wash and dry hands - “I,” “me” - Imitate vertical and horizontal lines - Parallel play - 18-24 months have mastered object permanent and flexibility in problem solving due to the development of a complex understanding of cause and effect

Answer 5

6yo At 6yo, children may understand there are rules but may have a hard time controlling impulses. By 8yo, children have developed a conscience and are aware of social expectations and rules.

Answer 6

One point is credited for each: 2 eyes, 2 ears, nose, mouth, hair, 2 arms, 2 legs, 2 hands, 2 feet, a neck, and a trunk. Each point converts to a value of ¼ added to a base of 3.

Answer 7

``` Early adolescence (10-13yo): Preoccupation with SELF, formation of same-sex peer groups. - Concrete cognition ```

Answer 8

``` Middle adolescence (14-17yo): PEER group. Move from concrete to abstract thought. Separation from family. Conflict within family peaks. - Feeling of omnipotence and immortality ```

Answer 9

``` Late adolescence (18-21yo): Individual relationships. Completion of a separate identity from parents. - Idealistic ```

Answer 10

Vegetarians | - Supplements needed: Vitamin B12, Iron, Calcium, Zinc

Answer 11

Vitamin A deficiency - Pt: - Impaired adaptation to darkness (night blindness), dry conjunctiva (xerophthalmia/ xerosis conjunctiva) - Bitot spots (keratinization of the cornea) - Progress to dry cornea (xerosis cornea)

Answer 12

Hypervitaminosis A | - Increased ICP, hypercalcemia

Answer 13

Vitamin C (Ascorbic acid) Deficiency (Scurvy) - Path - 1. Poor consumption of foods - 2. Consumption of overly heated foods. Classic is consumptions of evaporated boiled milk in infants - 3. Medical conditions resulting in decreased stores - Pt: - Fatigue and lethargy, corkscrew-coiled hairs / perifollicular keratosis that progresses to hemorrhage - Delayed wound healing and bleeding (gum inflammation and hemorrhage is classic) - Scurvy: Bone pain, joint hemorrhage, arthropathy - Osteopenia is very common with radiographic changes - Labs: Mild normochromic, normocytic anemia secondary to iron deficiency, folate deficiency, bleeding, and hemolysis - XR: Wimberg and Frankel lines, white dense lines around the growing metaphysics and epiphysis respectively, are rarely seen but are specific to scurvy. - Dx: Clinical. Assess body stores of vitamin C with leukocyte ascorbic acid level. - Tx: 100-300mg daily of vitamin C in children for 1mo

Answer 14

Vitamin E (alpha-tocopherol) deficiency - Pt with pancreatic dysfunction (such as CF population) are at risk - Pt: - Neurologic dysfunction, progressive ataxia, deceased DTRs, generalized weakness, visual changes - Hemolytic anemia with elevated relic and hyperbilirubinemia

Answer 15

\Vitamin B1 (Thiamine) deficiency - Dry beriberi - peripheral neuropathy - Wet beriberi - neuropathy in addition to cardiac failure - Wernicke encephalopathy - ophthalmoplegia, ataxia, and confusion

Answer 16

``` Vitamin B2 (Riboflavin) - Cheilosis, sore tongue ```

Answer 17

``` Vitamin B3 (Niacin) Deficiency - Pellegra - Pt: Diarrhea, dermatitis, dementia ```

Answer 18

Vitamin B12 (Cobalamin) Deficiency - Path: Strict vegetarian or vegan diets. Ileal disease. Pernicious anemia, Pancreatic insufficiency - Pt: - Peripheral neuropathy, hypotonia, developmental delay, failure to thrive - Labs: - Macrocytosis and hypersegmented neutrophils - Methylmalonic acid and total homocysteine levels are often markedly elevated.

Answer 19

Folate deficiency - Path: - Can result from inadequate dietary intake, increased metabolic demand (eg infancy, pregnancy, lactation), malabsorption, or metabolic interference (eg methotrexate, sulfonamide). - Consumption of a diet high in goat milk, which is low in folic acid - Goat milk is a poor source of folate and results in megaloblastic anemia in unsupplemented infants if used as the sole food. - Tx: 1-5 mg daily. - If patient has concomitant vitamin B12 deficiency, use high-dose folate can correct RBC problems but worsen neurologic manifestations of B12 deficiency. It is therefore important to determine if B12 deficiency is also present.

Answer 20

Vitamin K (Phylloquinone) deficiency - Pt: - 1. Early (within 24 hours after birth): Presents with 24 hours of life with cephalohematoma, intra-abdominal hemorrhage, and/or intracranial bleeding - 2. Classic (2-7 days); Occurs in infants, from day 2-7 of life with umbilical cord bleeding, GI hemorrhage, or oozing from puncture sites - 3. Late (2 weeks - 6mo): presents from ages 2-12 weeks - Labs: Mildly prolonged PT and PTT

Answer 21

Zinc deficiency - Path: - Micronutrient/trace mineral deficiency is a long-term adverse effect of bariatric surgery without appropriate supplementation - Lost in stool: Deficiency can occur in any chronic diarrhea - Pt: - Mild: Taste (hypogeusia) and smell impairment, night blindness, and depressed immunity. - Severe: Alopecia, bullous pustular dermatitis, diarrhea, and frequent infections due to a depressed immune system - Acrodermatitis enteropathica - see - Tx: 1-3 mg/kg/day PO elemental zinc

Answer 22

Subcutaneous: MMR, varicella, MMRV

Answer 23

Streptomycin, neomycin, polymyxin B: IPV

Answer 24

Neomycin: MMR, varicella, some diphtheria, tetanus, acellular pertussis (DTaP), hepatitis A, influenza, rabies

Answer 25

Gelatin: Influenza, MMR, varicella, MMRV, yellow fever, oral typhoid, rabies

Answer 26

Casein: DTap, Tdap (immunize and observe if severely milk allergic)

Answer 27

- Egg allergy is NOT a contraindication to the MMR vaccine. Neither premedication nor prolonged monitoring after vaccination is necessary.

Answer 28

- Yellow fever: is contraindicated in individuals with hypersensitivity to eggs or chicken proteins. Skin-prick testing be performed before administering

Answer 29

- Inactive influenza vaccine: Egg allergy is not a contraindication to IIV (IM inactivated influenza vaccine), and numerous studies have confirmed its safe administration. Current guidelines recommend vaccinating egg-allergic individuals in a medical setting with appropriate staffing and resources to tx an allergic reaction and monitoring of these patients for 30 mins after vaccine administration. - Intranasal live attenuated vaccine (LAIV) and intramuscular inactivated influenza vaccine (IIV) are cultured in fluid derived from chicken embryos.

Answer 30

- Live vaccines: BCG, OPV, MMR, varicella, intranasal influenza, rotavirus, smallpox, yellow fever

Answer 31

- Do not give live virus or live bacterial vaccines to children with congenital immune dysfunction, receiving immunosuppressive therapy, or undergoing BMT - Do NOT give OPV to household contacts of these children bc the vaccine strain can be transmitted in the household to the immunocompromised child. - IN influenza virus vaccine is live and poses a risk fo severely immunodeficient patients - Do NOT given live virus or bacterial vaccines to a child receiving >2 mg/kg of prednisone, either daily (total 20mg) or every other day, for >14 days. Child should be off steroids for at least 3 mo before you give these vaccines - No live vaccines during chemo. Wait for 3 mo after completion - Children with HIV receive MMR and varicella vaccines at 12mo of age unless they are severely immunocompromised. Do NOT give OPV to children with HIV.

Answer 32

Influenza - There is a small increased risk for febrile seizures during the 24 hours after simultaneous administration of trivalent IIV and the PCV13 vaccine. The same holds true with simultaneous administration of IIV and the DTaP vaccine. Therefore, caution parents regarding this potential risk. - Children age 6 months through 9 years should receive a 2 doses separated by at least 4 weeks during the 1st flu season

Answer 33

Hepatitis B virus - Typical schedule is at birth, at 1-2 months, and at 6 months. - When the mother is HBsAg-, the initial hepatitis B vaccine can be given within the first 2 mo. However, the AAP recommends that hospitals have policies in place to ensure administration of the 1st dose of HepB should be given prior to discharge to all infants >2kg at birth - If maternal hepatitis B surface antigen positive HBsAg+, baby must get Hep B Ig and Hep B vaccine <12 hours after birth. - if <2kg, 1st dose does not count toward the 3 doses. 3 additional doses should be given at 1, 2-3, and 6mo of age or 2, 4, and 6 months of age - If >2kg- 2nd and 3rd doses should be given at 2 and 6 mo of age - If maternal hepatitis B status is unknown, baby should get Hep B vaccine < 12 hours after birth and check mom’s HBsAg. HBIG can be deferred until maternal results become known. - If infant weight is >2000g, HBIG be given by 7 days of life (or hospital discharge if sooner) if mother remains HBsAg unknown or is found to be positive. - If infant weight is <2000g, HBIG would need to be given within 12 hours of delivery if the mother remained HBsAg unknown or was found to be positive.

Answer 34

Rotavirus - Only live vaccine administered prior to 1yo - The 1st dose must be administered from 6 weeks through 14 weeks 6 days of age. All doses must be completed by 8mo and 0 days. - Contraindications to vaccine: - Hx of intussusception: Increasing risk of intussusception with age is the reason for maximum age restrictions - SCID - Anaphylaxis allergy to latex (oral applicator for rotarix vaccine contains natural latex rubber)

Answer 35

HPV Vaccine - Recommended time for first dose is 11-12yo, but HPV vaccine can be started at age 9 - If initiated <15yo (9-14yo), need 2 vaccines separated by 6-12 months. - If start the series >15yo, need 3 vaccines administered at 0, 1-2 months after the first, and 6 months after the first

Answer 36

DTaP - 5 doses prior to 7yo: At 2mo, 4mo, 6 mo, 15-18mo, at 4-6 yrs (5th dose can be skipped if 4th dose given after age 4). - DTaP is for those <7 years. - For >7yo, use Tdap - For children >7yo who are unimmunized or who have not completed the DTaP series the 1st dose in the catch-up series should be Tdap. - In children 7-10yo who require a dose of Tdap to catch up from an incomplete DTaP series, the 11-12yo dose of Tdap can be waived. - Absolute CI to pertussis-containing vaccines: - Anaphylaxis following a previous vaccination - Encephalopathy within 7 days of receipt - Progressive neurologic disorder, infantile spasms, uncontrolled epilepsy, progressive encephalopathy, developmental delay of unknown etiology - Precautions: - Guillain-Barre syndrome within 6 weeks after a previous tetanus toxoid-containing vaccine - Moderate-severe acute illness with or without a fever (until resolution) - In previously unimmunized children 1-6 yo with a medical contraindication to a pertussis-containing vaccine, administer 2 doses of DT approximately 2 months apart, followed by a 3rd dose in 6-12 months to complete the initial series.

Answer 37

MMR - Absolute CI: - Anaphylaxis to prior MMR vaccination or to neomycin or gelatin - Severe Immunodeficiency: cancer, blood dyscrasia, acquired immunodeficiency, on immunosuppressive therapy - Exception: HIV-infected children should receive MMR in the absence of severe immunosuppression, defined as CD4 >15% for >6 mo for persons <5 yo; CD4 >15% and/or CD4 count >200 lymphocytes/uL for >6 mo for persons >5 yo. - Pregnancy - Current active infection - Immunoglobulin preparations interfere with serologic response to MMR. If possible, give MMR at least 2 weeks before giving immunoglobulin. - TB: If the PPD test is not given on the same day as or before the MMR, wait 4-6 weeks after the MMR or MMRV vaccine before placing the PPD. - In children receiving high-dose (2mg/kg/day or >20mg/day) oral corticosteroids for >14 days, delay MMR for at least 1 month after completion of corticosteroid therapy. - International travel or US areas that are high risk (California, New York, Washington, New Jersey, Michigan) - Infants 6-11 months: 1 dose before departure (does not count to 2-dose series). Revaccinate with 2 doses at 12-15 mo and 2nd dose at school entry 4-6yo - Measles post-exposure prophylaxis: - see “infectious rashes” - MMR vaccine (for immunocompetent infants >12mo) within 72 hours of exposure - OR immunoglobulin (for immunocompromised, pregnant without evidence of immunity, infants <12mo) within 6 days of exposure

Answer 38

Varicella - 1st dose at 12-15mo, 2nd dose at 4-6yo. - Minimum Interval - For <13yo, 12 weeks apart - If >13yo, if not administered during same visit, 4 weeks apart - CI: - Anaphylaxis to neomycin - Anaphylaxis to gelatin - Pregnancy - Immunocompromised children, except those with impaired immunity (see MMR) - Children receiving high-dose oral steroids, ( >2 weeks of >20mg/day or prednisone >2mg/kg/day in children <10kg), delay varicella vaccination for at least 1 month - Other altering circumstances: - Recent blood transfusion or immune globulin therapy - antibodies in blood products can block the immune response - Antiviral therapy - varicella virus is susceptible to acyclovir, valacyclovir, and famciclovir. These antivirals should be avoided 1 day prior to vaccine until 21 days after administration - Aspirin therapy - therapy should be avoided for at least 6 weeks after varivax administration bc of the association between aspirin (salicylates), varicella infection, and Reye syndrome

Answer 39

MMRV - Children 12-23 mo are twice as likely to have a febrile seizure 5-12 days following MMRV - MMRV is the preferred preparation for the 1st dose in children >48 months of age and for the 2nd dose at any age (15mo - 12yo) in order to minimize the number of injections. - MMR and varicella can be simultaneously administered at separate sites; however, if they are not administered during the same visit, they must be separated by >28 days - Children with HIV receive MMR and varicella at 12mo of age unless they are severely immunocompromised

Answer 40

PCV13 and Hib are not routinely given to healthy children after 59mo of age

Answer 41

ActHib - 4th dose is only necessary for 12-59mo who received 3 doses before the 1st birthday - If pt has not received recommended doses, catch-up vaccination is recommended - Only 1 dose of Hib is required between 15-60 mo, regardless of previous immunization status. If 1st dose is given >15mo age, then no further doses are needed. - Latest can receive is age 5yo (unless HIV, asplenia, immunocompromised) - Hib vaccine is not recommended for unvaccinated immunocompetent children >5yo ****- 1 dose ActHib is recommended for unvaccinated/partially vaccinated children >5 yo with immunocompromising conditions, including those with functional or anatomic asplenia or HIV infection.***

Answer 42

Conjugated Pneumococcal PCV-13 - 4th dose is only necessary for children 12-59mo who received 3 doses before 12mo or for children at high risk who received 3 doses at any age - Unvaccinated or incompletely vaccinated, healthy children 24-59 mo of age (>2yo) should receive a single dose of PCV13. PCV13 For 2-6yo high risk patients: - Unvaccinated/<3 PCV13 doses require 2 doses of PCV13 8 weeks apart - If received 3 previous doses of PCV13, only 1 additional dose 6-18yo at high risk never received PCV13/PPSV23 should receive 1 dose of PCV13 followed by PPSV23 at least 8 weeks later and a 2nd dose of PPSV23 5 years after the 1st

Answer 43

Pneumococcal polysaccharide PPSV23 - For children 24-71mo in high-risk groups who have completed the recommended number of PCV13 doses, PPSV23 is recommended at 2 years of age (and at least 8 weeks after the most recent dose of PCV13), followed by a 2nd dose 5 years later for the subset of children with immunocompromising conditions, sickle cell disease, or other hemoglobinopathies, or functional/anatomic asplenia. 2-6yo: PPSV23 #1, at least 8 weeks after most recent PCV13 7yo or in 5 years from 1st dose: PPSV23 #2 for immunocompromised, sickle cell disease, other hemoglobinopathies, functional/anatomic asplenia, HIV, chronic renal failure, nephrotic syndrome

Answer 44

Meningococcal Quadrivalent ACWY (Menactra, Menveo) - Recommended for all US children at 11-12 yo adolescent visit, with a booster dose at age 16yo to enhance protection during the period of highest risk (18-23yo, esp college freshman). - Administer vaccine at 13-18 years if not previously vaccinated - If the first dose is administered at 13-15 years, a booster dose is recommended at 16-18 years. - If the first dose is administered at >16 years, a booster dose is not indicated. High Risk: Complement deficiencies, functional/anatomic asplenia (sickle cell disease), HIV infection, travel to country with high rates, military recruits High Risk with NORMAL Splenic function 2-24mo: - MenHibrix (Hib-MenCY): 2, 4, 6, and 12-15mo - Menveo (MCV4): 2, 4, 6, and 12-15mo - Menactra (MCV4): 2 dose (3 mo apart at 9-23 mo) 2yo-10yo - 2 dose series of Menveo or Menactra (2 mo apart) >11yo - 2 dose series of Menveo or Menactra (2 mo apart) High Risk with ASPLENIA - 2-18mo: - Menveo or MenHibrix: 2, 4, 6, 12-15mo - Previously unimmunized 19-23mo (2 doses Menveo 3mo apart) - Do NOT administer Menactra until >4 weeks after completion of all PCV13 (bc interference)

Answer 45

Meningococcal B (Bexsero, Trumenba) - Recommended only in children >10 yo at increased risk for meningococcal disease. - For children >10yo with asplenia (anatomical or functional), persistent complement component deficiency, or HIV who have not received a complete set of meningococcal vaccinations, administer the 2-dose MenB4C or the 3-dose MenB-FHbp.

Answer 46

Sports Preparticipation Consider referral if 1 or more of the hx or physical exam elements are positive - Syncope occurring with exertional activities is extremely concerning symptoms that merits additional evaluation for underlying heart disease - Bradycardia (unless HR <30 beats/min) and 1st degree bundle branch block are examples of findings considered to be normal variants in young athletes that might otherwise be of concern. AAP does not recommend participation in power lifting, body building, or 1-repetition maximum lift exercises by children who are skeletally immature.

Answer 47

Conditions that have life-threatening complications and therefore restrict sports participation include - Hypertrophic cardiomyopathy - Prolonged QT interval - Aortic stenosis - Coronary artery anomalies - Myocarditis - Uncontrolled Stage 2 hypertension - Fever (increases risk of heat illness) - Concussion (if still symptomatic)

Answer 48

Conditions that require a treatment plan for sports participation include - Asthma - Hypertension - Diabetes mellitus - Eating disorders - Musculoskeletal disorders/injuries - Concussion

Answer 49

Side effects of caffeine: - Diuretic, resulting in increased UOP during and after an exercise. - Myocardial infarction, convulsions, cardiac arrest, arrhythmias, anaphylaxis, spontaneous abortion, renal and liver impairment, and psychiatric disorders associated with heavy consumption of energy drinks. - Massive overuse of beverages by US soldiers has caused insomnia (<4h of sleep/night) and sleep disruption due to stress and illness

Answer 50

Athletes are considered functionally 1-eyed if they have corrected vision of worse than 20/40 in 1 eye. - Sports that are considered high risk for eye injury and would require protective eyewear for participation: Baseball, basketball, hockey, lacrosse, and racket sports - Sports that are higher-risk for eye injury and functionally one-eye athletes should not participate in these even with appropriate goggles: Wrestling, full-contact martial arts, boxing

Answer 51

Conditions that require special considerations - Down syndrome - Predisposition to atlantoaxial (C1-C2) instability and must be examined for this. If exam is abnormal and/or patients are asymptomatic, order cervical imaging and a pediatric neurosurgeon or ortho consult. - While atlantoaxial instability is a concern in children with trisomy 21, a screening XR is no longer indicated. - Seizure disorder - Should not participate in free climbing, hang-gliding, or scuba diving. Water sports are fine if seizure disorder is well controlled and there is adequate supervision. Certain sports - such as horse-back riding, harnessed rock climbing, and gymnastics - are permissible if precautions are taken. - Type 1 diabetes - Can participate in sport activities but must closely monitor their blood glucose levels before, during, and after exercise (for up to 12 hours). - Hypertension - Children and adolescents with elevated BP (preHTN) or stage 1 HTN may participate in competitive sports once HTNive target organ effects (including LV hypertrophy) and risk have been assessed - It is important to remember that athletic conditioning itself may lead to LV hypertrophy; distinguishing between pathologic and physiologic changes may be difficult. - AHA and AAP more specifically recommend that athletes with stage 2 HTN should be restricted from high static activity until BP is under control. - Marfan syndrome - Can typically participate in low-moderate intensity exercise (eg bowling, walking). Contact sports and scuba diving are not advisable, secondary to risk of cardiovascular bleed/lens dislocation and precipitating a pneumothorax, respectively. - Sickle cell trait - increased risk of rhabdomyolysis with intense physical activity

Answer 52

CRAFFT questionnaire is a quick assessment for adolescents for substance use/abuse - C: Have you ever driven a car while being high or ridden in a car with someone who was driving high? - R: Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in? - A: Do you ever use alcohol or drugs while you are by yourself (or alone)? - F: Do you ever forget things you did while using alcohol or drugs? - F: Do your family or friends ever tell you that you should cut down on your drinking or drug use? - T: Have you ever gotten into trouble while you were using alcohol or drugs?

Development Flashcards

(106 cards)