Peds

Question 1

Childhood ages

Answer 1

• neonate 0-28 days
• infancy 1st year of life
• Toddler 1-2
• preschool 3-4
• school age 5-12

Question 2

2 week old

Answer 2

• visual prefrerence for human face - vision range 8-12”
• hear high pitch voices best
• reacts to crys of othe neonates
• well-developed snse of smell

Question 3

stepping reflex

Answer 3

• walking motion made with legs and feet when heald upright
• appears for the 1st 3-4 months then reappears at 12-24 months

Question 4

rooting reflex

Answer 4

• turning head and sucking when cheek stroked
• no longer seen by 6-12 months

Question 5

Moro/startle reflex

Answer 5

• throwing out arms and legs followed by pulling them back to the body following sudden movement or loud noise
• no longer seen after 16 weeks

Question 6

Palmar grasp

Answer 6

• grasping object placed in the hand
• no longer seen by 2-3 months

Question 7

Babinski reflex

Answer 7

• stoking the sole of the foot elicits fanning of the toes
• no longer seen by 6 months

Question 8

neonate stomach size

Answer 8

day1 cherry size
day 7 apricot
day 30 egg

Question 9

Infant feeding

Answer 9

• exclusively breast fed for first 6 months
• introduce compplementry foods no sooner than 4 months
• continue breast feeding for 1 year or longer
• if not breast feeding infant formula 1st year as major caloric source

baby should be back to birth weight by 2 weeks

Question 10

Hyperbilirubinemia in newborn

Answer 10

• immature intestinal tract cannot reduce bilirubin to urobilinogen for excretion

Onset >24
* Pathologic jaundice - less common
* caused by metabolic disorders, hmeolytic disorder, sepsis …
* Intervention: treat underlying illness, ensure adequate fluid intake, Phototherapy if total serum bili >25

Onset <24 - 2 wks
* physiologic jaundice - most common reason, usually in the first 4-5 days of life
*Breast milk jaundice - usually after 1 wk
* Intervention: ensure adequate fluid intake, phototherapy if t. billi > 25

Question 11

Hyperbilirubinemia in newborn
labs

Answer 11

• jaundice starts in the face and works its way down the body
• labs are required to dx degree of jaundice

Direct (conjugated) bili: hemolyzed RBC able to be excreted; elevated due to: sepsis, intrauterine infection, severe hymolytic disease, biliary atresia…

Indirect (unconjugated) bili: hemolyzed RBC not able to be excreted; uaually related to positive Coombs test (Blood groups Rh, ABO incompatibility)

Question 12

Chemosis - conjuntival edema

Answer 12

• chemical irritation from neonatal chemoprophylaxis
• chlamydial (inclusion) conjunctivitis - s/s 5-14 days post exposure, chemosis common. prevent via maternal screen. confirm with culture, treat with oral erythromycin x2weeks
• Gonococcal conjunctivitis - incubation beriod after exposure 2-7 days . Ocular chemoprophylaxis at birth with erythromycin opthalmic ointment or silver nitrate minimizes risk
• Neonatal adenovirus - common cold pathogen- causitive organism of viral conjunctivitis, usually with ecessive tearing, mildly red conjuntiva and URI symotoms

Question 13

2 month milestones

Answer 13

• from tummy can lift selft with 2 arms
• resonds 2 sounds
• smiles when smiled 2

Question 14

4 month milestone

Answer 14

• reaches 4 a toy or object
• smiles 4 fun (spontaneously)
• rolls from tummy to back

Question 15

6 month milestone

Answer 15

• looks like number 6 when sitting
• rolls from back to tummy and back

Question 16

6 to 8 months

Answer 16

• able to sit up unsupported
• transferrs objects from hand to hand

Question 17

12 months

Answer 17

beging to walk

Question 18

18 months

Answer 18

canname single word objects
copys adults
says no alot

Question 19

2 years

Answer 19

• 2 word sentences
• follows 2 step commands
• walk up steps with help
• bultds a tower with 2 blocks

Question 20

3 years

Answer 20

• bulids 3 block tower
• speaks in 3 word sentance
• trides a trike
• draw a circle

Question 21

Speech milestones

Answer 21

• percent of words understadable by adult not in daily contact with child
• 16-18 months 25%
• 19-21 months 50%
• 2-2.5 yrs 75%
• 3-4 years nearly 100%

Question 22

develpomental redflags

Answer 22

• 6 months: no big smiles or other warm joyful expressions
• 9 months: no back and forth sharing of sounds, smiles, or other expressions
• 12 months: lack of response to name, no babbleing, and/or no back and forth gestures, shuch as pointing, reaching, showing, or waving
• 16 months: no spoken words
• 24 months: no meaningful two-word phrases that don’t involve repeating

Question 23

Childhood anemia

Answer 23

• most common type IDA - microcytic, hypochromic, elevated RDW
• most common in children 12-30 months
• depletion of birth iron stores (usually lasts till 6 months), initiation of lower-iron diet in later infancy, early todler stage
• most calories in 1sy year should be from breast milk with iron supplementation statring at 4- 6 months unless iron fortified formula or foods
• > 12 months, most potent risk factor for IDA is cows milk >16 oz/day
• in <9 months, most potent risk is maternal iron depletion or preterm infant

Question 24

Diagnosis of AOM in children

Answer 24

• moderate or severe buldging of TM OR new onset of otorrhea not related to otitis externa, and Otalgia
• mild buldging of TM and recent (<48 hrs) onset of ear pain ( tugging, holding, rubbing) or Intense TM erythema with otalgia

Question 25

Management of AOM

Answer 25

* treat ear pain - alagesics: acetaminophen or ibuprofen

Question 26

watchfull waiting for AOM

Answer 26

in otherwise well child may not need to immediately start abx: * low risk of adverse outcome without ABx, high rate of spontaneous resolution without abx analgesia without abx is acceptable if * >6 months and unilateral infection with non severe illness based on joint decision with provider and parent. follow up in 48-72 hours with ability to start abx if no improvement or worsening

Question 27

severe vs nonsevere AOM in children

Answer 27

nonsevere * mild otalgia for <48hours or * fever < 39/102.2 in the past 24 hours Severe * moderate to sever otalgia or * otalgia >48 hours or * fever>39/102.2

Question 28

ABX tx for AOM at time of diagnosis

Answer 28

* reguradless of severity or laterality if <6 months * severe illness with unilateral or bilateral in >6 months * nonsevere illness with bilateral AOM in young children 6-24 months

Question 29

1st line tx for AOM

Answer 29

* amoxicillin 80-90mg/kg/d * amioxicillin-clavulante length of therapy * <2 yrs : 10 days * 2-6 yrs: 7 days * >6 yrs 5-7 days

Question 30

AOM with PCN allergy

Answer 30

cefdinir, cefuroxime, cefpodoxime

Question 31

Otitis media with effusion

Answer 31

* fluid in middle ear without s/s of infection (anticipated finding after AOM) * 1st line: watful waiting - 75-90% resolve in 3 months without specific treatment (abx, oral antihistamines, decongestants not indicated) * consider audiologic eval if persists more than 3 months, or concers for hearing, speech, or language concerns after prior audiologic test - referal to ENT and/or speach therapy

Question 32

scarlet fever

Answer 32

* S. pyogenes pharyngitis with sanpaper like rash * exudative pharangytis, fever, HA, tender localized anterior cervicle lymphadenopathy * rash usually reeupts on day 2 of pharyngitis and often peels away a few days later

Question 33

Roseola

Answer 33

* human herpesvirus -6 * yonger child with peack at 6-24 months * fever spike * discrete rosy-pink macular or maculopapular rash lasting hours to 3-days, follws a 3-7 dya period of fever, often quite high

Question 34

Rubella/3 day measles/german measles

Answer 34

* mild symptoms - fever sore throat, malaise, diffuse maculopapular rash lasting about 3 days * Posterior cervicle and postauricular lymphadenopathy begining 5-10 days prior to onset and present during rash * Arthralgia in about 25% (most common in women) * risk in pregnancy to the fetus * vaccine preventable

Question 35

Rebeola/10 day measles/hard measles/measles

Answer 35

* usually acute presentation * fever nasal discharge, cough, generalized lymphadenopathy, conjunctivitis (copious clear discharge), photophobia * Koplik spots - appearing 2 days prior to onset of rash as white spots with blue rings held within red spots in oral mucosa * pharyngitits is usually mild without exudate * maculopapular rash onset 3-4 days after onset of symptoms, my coalesc * vaccine preventable