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206 Cards in this Set
- Front
- Back
|
necrotizing enterocolitis (NEC) ABX
|
gentamicin
clindamycin ampicillin |
|
pharyngoconjunctival fever etiology
|
adenovirus (35 serotypes)
|
|
hand-foot-mouth disease etiology
|
coxsachie virus
|
|
herpes simplex stomatitis Tx
|
Supportive to avoid dehydration
1) acetominophen 2) popsicles, smoothies, etc 3) 1:1:1 cocktail of Maalox:Benadryl:lidocaine, 5-15cc 4x daily |
|
hallmark lymphadenopathy locations in mononucleosis
|
posterior auricular, anterior cervical
|
|
Avoid which ABX in mononucleosis?
|
amoxicillin or ampicillin
|
|
Bacterial pharyngitis etiology and Tx
|
Etiology: Most common Group A Strep
Tx: Pen VK or Amoxicillin or Cephalexin, Clindamycin, macrolide |
|
Etiology of diphtheria
|
Corynebacterium diphtheriae
Corynebacterium ulcerans |
|
diphtheria symptoms
|
Membranous pharyngitis
enlarged anterior cervical lymphaden. Edema - ("Bull Neck") |
|
epiglottitis etiology
|
H. influenzae type B
(It is rare because of the vaccine) |
|
epiglottitis Tx
|
Intubation to guarantee airway
ABX: 3rd gen cephalosporin = (cefotaxime, ceftriaxone) |
|
Croup's other name
|
Laryngotracheobronchitis
|
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Most common etiology of Croup
|
parainfluenza
|
|
epiglottitis x-ray finding
|
thumb sign
|
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croup x-ray finding
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steeple sign
|
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croup symptoms
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SEAL LIKE BARK
URI PRODOME steeple sign on AP xray of neck |
|
croup treatment
|
cool mist
systemic steroids racemic (aerosolized epi) |
|
bronchiolitis etiology
|
RSV (Respiratory Syncitial Virus)
|
|
pertussis etiology
|
bordetella pertussis
a.k.a. Whooping Cough |
|
pertussis Tx
|
erythromycin
azythromycin clarithromycin (these are the macrolides) |
|
MCHAT screening
|
Texas Health Steps = 18 months.
in general/Dekat's notes = 16-30 months |
|
what age do you switch from measuring length to height ?
|
3 y/o
|
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what age do you start measuring BMI?
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24 months
|
|
what age do you start screening BP
|
3 y/o
|
|
most common cause of HTN in infants
|
kidney disease
|
|
what age to stop measuring FOC (fronto occipital circumference)?
|
24 months
|
|
age to start formal eye exams?
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attempt at age 3
|
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when to start formal audiometry teesting?
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age 4
|
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newborn hearing screening
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12 hours old
ABR - auditory brainstem response OAE - otoacoustic emissions |
|
Newborn screening labs drawn when?
What do they look for? |
Look for congenital & heritable disorders
Drawn 24-48 hours Then again at 1-2 weeks. |
|
what age to check H&H for anemia screening?
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12 months, 18 months.
Also 12 years in females |
|
TB questionnaire screening
|
annual TB questionnaire starting at 12 months.
PPD if at risk |
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Lead poisoning screening
|
12 and 24 months. blood tests
Lead Risk questionnaire annually between 3-6 years. |
|
Lead poisoning symptoms/signs
|
Often no symptoms OR
1) pica 2) anorexia 3) colicky abdominal pain 4) irritability 5) FTT 6) pallor 7) mental development delay 8) CNS symptoms at high levels 9) hypochromic anemia 10) lead lines on xrays of knee/wrist |
|
well child visit contains...
|
history
physical screening labs anticipatory guidance immunizations. |
|
Car Seat guidelines
|
Phase 1: birth - 35# (or up to age 2) = rear-facing seat
Phase 2: toddlers/preschoolers. forward facing seat with 5 point harness at or above shoulder Phase 3: school aged children > 40#. booster with shoulder/lap belt. Phase 4: older children. adult shoulder/lap belt when large enough (4'9" or 100#). In back seat till age 13. |
|
Vaccines at birth
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HBV-1
|
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Hep B Sequence
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birth, 2 months, 6 months
|
|
Vaccine sequence starting at 2 months
(6) |
HBV-2, DTaP-1, Hib-1, IPV-1, PCV-1, RV-1
|
|
Vaccine sequence at 4 months
|
Same as month 2 but without HBV-2.
(DTaP-2, Hib-2, IPV-2, PCV-2, RV-2) |
|
Vaccine schedule at 6 months
|
HBV-3, DTaP-3, IPV-3, Hib-3 (depends on brand), RV-3, PCV-3
|
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Vaccines at 12-15 months
|
Varicella, HAV-1, MMR-1, Hib (3 or 4 depending on brand), PCV-4
|
|
vaccines at 15-18 months
|
DTaP-4, HAV-2
|
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vaccines at 4-6 years
|
DTaP-5, IPV-4, MMR-2, varicella
|
|
vaccines at 11 - 12 years
|
Tdap, MCV4, HPV
|
|
influenza vaccine
|
yearly
between 6mo-8yrs, need 2 doses |
|
DTaP contraindications (5)
|
If after last vaccine:
encephalopathy within 7 days fever > 105 within 48 hours collapse/shock seizure within 3 days crying inconsolably > 3 hrs within 2 days |
|
Live attenuate vaccine contraindications
|
MMR & Varivax
1) anaphylaxis to eggs 2) immunodeficiency 3) recent immunoglobulin |
|
What age do neonates become infants?
|
4 wks
|
|
What prenatal maternal screening tests should occur?
|
rubella, HIV, Hep B, symphilis, GBS (5)
Serum alfa fetoprotein (MSAFP) in 2nd trimester (neural tube defects, gastroschisis, polycystic kidneys Amniocentesis fo high risk pregnancies (trisomy 21,18,13) *Fetal US * Maternal Infxns History - STDs, parvovirus |
|
maternal hypertension can lead to
|
intrauterine growth retardation
|
|
maternal lupus possible effects on newborn
|
"SCCRANT"
stillbirth congenital heart block cardiomyopathy rash anemia neutropenia thrombocytopenia |
|
maternal DM possible effects on newborn
|
"3 lows and a high"
Low glucose, calcium, Mg Hi RBCs (polycythemia) * Also, LGA (large for gestational age) * congenital anomalies (cardiac, sacral agenesis, caudal regression dyndrome) |
|
maternal anti-epileptic use
|
midface hypoplasia
CNS, limb, cardiac malformation |
|
maternal retinoids use (accutane)
|
miscarriage
abnormal face |
|
maternal tetracycline use
|
enamel hypoplasia of unerrupted teeth
|
|
maternal lithium use
|
congenital heart disease
|
|
maternal DES use
|
adenocarcinoma of cervix/vagina in offspring
|
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maternal thalidomide use
|
phocomelia (limb shortening)
|
|
maternal nicotine use
|
SGA (small for gestational age) - secondary to placental insufficiency since it substitutes CO for O2 at placenta.
|
|
Fetal Alcohol Syndrome characteristics
|
growth restriction
characteristic facies (low nasal bridge, absent philtrum, small head, lsmall eye openings, short nose, thin upper lip, flat midface, epicanthal folds) - SMOOTH PHILTRUM, THIN UPPER LIP Also developmental delay & cardiac defects |
|
Apgar Score Use
|
*Evaluate at 1 min and 5 min after birth
5 Categories: HR, Respiratory Effort, Muscle Tone, Color, Response to cath in nares * Total score out of 10. 8-10 = normal, 0-4 = severe depression. |
|
neonatal conjunctivitis pathogens and prevention
|
prevention of gonococcal conjunctivitis at birth: 1% silver nitrate or erythromycin.
Within 1-7 days = N. gonorrhea (copious purulence) 4-19 days (after 7 days) = C. trachomatis (scant purulence) |
|
How do you prevent hemorrhagic disease of the newborn
|
Vitamin K IM (due to a deficiency of VitK)
|
|
acrocyanosis
|
blue cast when exposed to cold. normal finding in neonates
|
|
cutis marmorata
|
lattice-like bluish mottled appearance. normal finding in neonates
|
|
avg HR in neonates, infants,
|
birth 90-190
0-6 months 80-180 6-12 months 75-155 |
|
caput succedaneum vs cephalohematoma physical exam findings in newborn
|
caput succedaneum - edema in skin. crosses suture lines. resolves 1-2 days
cephalohematoma - subperiosteal bleed. does not cross suture line. resolves 3 wks. |
|
when do anterior & posterior fontanelles close
|
anterior - 4-26 months
posterior - by 2 months |
|
what is "synostosis"?
|
premature fusion of sutures
|
|
what are "craniotabes"?
|
soft areas in the skull like ping pong ball.
think Congenital symphilis |
|
upslanting palpebral fissures
|
Down Syndrome
|
|
leukokoria
|
a white reflex instead of a red reflex from the eye. signifies potential pathology: cataract, retinoblastoma, detachment, etc
|
|
small, deformed, or low-set pinna in neonate
|
common congenital defect, esp with KIDNEY DISEASE
|
|
epstein pearls
|
neontal epidermal inclusion cysts in mouth will resolve spontaneously. often on hard palate, alveolar ridge
|
|
signs of respiratory distress in neonates
|
retractions (supraclav, intracost, subcost)
nasal flaring grunting wheezing stridor |
|
normal breathing in newborns
|
normal rate 30-40
can alternate with periodic breathing at slow rate and occasional apnea up to 5-10 seconds. |
|
absence of femoral pulses implies
|
coarctation of aorta
|
|
HR of neonate
|
90 at rest
180 when active 140-150 in premie |
|
BP of nenate/infant
|
systolic 70 @ birth
85 @ one month 90 @ 6 months |
|
meconium should pass when?
|
12 hours after birth
|
|
hypospadias in newborn
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urethral opening dislocated
|
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cryptorchidism
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undescended testicle
|
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Galeazzi sign
|
thighs and kness flexed. Uneven knee levels indicates possible DDH
|
|
Barlow & Ortolani Test
|
Barlow - Flexing and Adducting thigh
Ortolani - reduces hip . feel for "clunk" when it enters acetablum. Positive tests indicate potential for DDH |
|
DDH common in
|
breech deliveries
|
|
Erb-Duchenne Palsy
|
brachial plexus injury C5-C7
"waiter's tip" position |
|
Klumpe position
|
brachial plexus injury C7-T1
"claw-like" position ; elbow flexed, hand up. "E comes before K" |
|
which primitive reflexes disappear when?
|
2-3 months : Assymetric tonic neck reflex, Galant
3-4 : palmar grasp 4-6 : moro, rooting, placing/stepping, positive supporting neck. |
|
intrauterine growth retardation
|
<2500g born after 37 weeks GA
|
|
congenital infections
|
TORCH
Toxoplasmosis Other = parvovirus (causes Fifths Dz), syphilis Rubella CMV HSV, hepatitis, HIV |
|
Bacteria that cause sepsis & meningitis in neonates
|
LEG
Group B Strep E.Coli Listeria |
|
Bacteria that cause conjunctivitis in neonates
|
chlamydia
gonorrhea |
|
Bacteria that cause pneumonia in neonates
|
C-LEGS
group B strep E Coli Listeria S. aureus chlamydia |
|
tx for physiological jaundice
|
phototherapy
|
|
chlamydia in the newborn can cause
|
pneumonia
conjunctivitis |
|
another name for Down's Syndrome
|
trisomy 21
|
|
common cardiac defects in trisomy 21
|
AV Canal
VSD (ventriculoseptal defects) in 50% of patients |
|
another name for trisomy 18
|
Edwards Syndrome
|
|
klinefelter syndrome genotype
|
extra sex chromosomes
47XXY, 48XXXY, 48XXYY |
|
klinefelter syndrome therapy
|
testosterone therapy during adolescence
|
|
turner syndrome genotype
|
45XO
|
|
turner syndrome cardiac findings
|
coarctation of the aorta
bicuspid aortic valve |
|
turner syndrome treatment
|
growth hormone starting ages 2-5
estrogen replacement adolescent thryoid replacement repair of coarctation |
|
what is aortic coarctation
|
narrowing of the aorta
|
|
congenital adrenal hyperplasia inheritance pattern
|
autosomal recessive
|
|
Congenital adrenal hyperplasia health risks
|
no aldosterone production leads to low plasma Na, high K, acidosis.
Tx: gluco, mineralcorticoids |
|
asthma management steps 1-6
|
step 1 = mild = rescue SABA PRN
step 2 = mild persistent = Low dose inhaled corticosteroids OR cromolyn OR LTM (singulair) Step 3 = moderate = low dose ICS + LABA OR medium dose ICS Step 4 = moderate = medium dose ICS + LABA Step 5 = severe = high dose ICS + LABA Step 6 = severe = high dose ICS + LABA + oral steroids |
|
LABA's used for asthma
|
serevent and foradil
|
|
how to test for CF
|
sweat test. excessive concentration of Na and CL.
|
|
CF infancy symptoms
|
1) meconium ileus as newborn
2) prolonged jaundice 3) recurrent chset infxns 4) pancreatic exocrine insufficiency -> steatorrhea |
|
CF lung infection pathogens
|
S. aureus
H Flu Pseudomonas (eventually) |
|
CF management
|
1) regular spiromtry (marker of severity)
2) physiotherapy 2/wk for secretion clearance 3) prophylactic abx with rescue for exacerbations nebulized anti-psudomonal abx, DNase (to decrease viscosity) and/or hypertonic saline 4) pancreatic enzymes, vitamins 5) exercise 6) potential lung transplant |
|
bronchiolitis prevention med
|
RSV - respiratory syncital Virus
Synagis Monoclonal Antibody. $1000 /vial -> share with others. |
|
most common kidney neoplasm in children?
|
Wilm's tumor
|
|
rate of fluid resuscitation for moderately dehydrated kids
|
100ml/kg over 4 hours
|
|
most common age for acute otitis media
|
6-12 months
|
|
bacterial pathogens responsible for Acute otitis media
|
1) Strep pneumo
2) nontypeable H. influenzae 3) Moraxella catarrhalis 4) group A Strep |
|
treatment guidelines for acute otitis media with CERTAIN and UNCERTAIN diagnosis for 3 age groups
|
1) < 6 months. certain = abx. uncertain = abx
2) 6 mo - 2yr. certain = abx. uncertain = abx if severe. non severe = observe 3) above 2yr. certain = abx if severe. observe if non severe. uncertain = observe |
|
drug and dose for actue otits media
|
no risk of abx resistance --> AMOXICILLIN 80-90mg/kg/day (in 2-3 doses)
if abx resistance --> AUGMENTIN 30-40mg/kg/d (in 2 doses) OMNICEF 14mg/kg/d (in 1-2 doses) |
|
prevention for recurrent otitis media
|
BREAST FEED
no bottle propping smoke free home possible prophylactic abx |
|
tx for otitis media with effusion
|
usually spontaneous resolution
audiogram is > 3-6 months myringotomy and venitlation tubes if hearing loss |
|
otitis externa pathogen
|
PSEUDOMONAS
Enterobacteriaceae Proteus fungi |
|
otitis externa tx
|
eardrops with wick if needed
Polymyxin B/neomycin/hydrocortisone Ciproflox Bactrim |
|
cause of acute viral gastroenteritis
|
rotavirus
other include: calcivirus, astrovirus, coronavirus, enterovirus [RECCA] |
|
shigella symptoms
|
high fever
seizures high WBC diarrhea |
|
shigella tx
|
ceftriaxone
azithro fluoroquinolone |
|
campylobacter Symptoms
|
"crampy"
SEVERE abdominal pain (can mimic appendicitis) |
|
campylobacter Tx
|
macrolides:
erythro, azithroy |
|
salmonella source & symptoms
|
from raw eggs, turtles, iguanas
|
|
salmonella tx
|
Don't treat in normal population due to prolonged carrier state
Treat if < 3 months old, bacteremic, sickle cell, or immunosuppressed. Use cefotaxime, ceftriaxone, azithro |
|
giardia symptoms and history
|
foamy, foul smelling, copious diarrhea
associated with daycare outbreaks |
|
giardia tx
|
metronidazole 15mg/kg/d (in 3 doses) x 5 days
|
|
functional abdominal pain symptoms
|
PERIUMBILICAL pain
no diarrhea no vomitting no fever |
|
Kawasaki disease sx and sx
|
lots of "K" sounding things:
1) cracked lips (and red) 2) coronary arteries can have aneurysms, narrowing and lead to MI 3) conjunctival injections 4) cervical lymphadenopathy 5) morbilliform rash 6) swollen hands, peeling fingers |
|
Kawasaki dz tx
|
1) echo to assess for coronary aneurysms
2) IV Ig (decreases coronary aneyrism risk) - hospital admission for this 3) aspirin as anti-inflam/anti-platel to decrease thrombosis |
|
measles symptoms
|
1) morbilliform rash on 3rd day of ilnness
2) preceeded by coryza (acute rhinitis) 3) conjunctivitis 4) koplick spots on buccal mucosa |
|
mumps symptoms
|
1) parotitis - initially unilateral -> bilateral
2) assoc with ear pain or pain eating/drinking 3) can cause orchitis in post-pubertal boys |
|
rubella symptoms and signs
|
AKA german measules
* kind of a milder form of measles (rubeola) 1) mild URI, low grade fever 2) DAY 1 has rash (unlike measles) 3) POST AURICULAR, POST CERVICAL, OCCIPITAL NODES 3) arthralgias It is a TORCH dz, therefore it is problematic if a pregnant woman gets it. causes BLUEBERRY MUFFIN BABY, congenital catarrhacts, microcephaly. devastating. |
|
Roseloa symptoms (and alternative name)
|
exanthem subitum
1) HIGH FEVER for 3-4 days (103-105) 2) no rash until fever goes away. 3) usually by age 2 |
|
roseola pathogen
|
Human herpesvirus 6 and 7 (HHV)
|
|
fifth disease alternate name and symptoms and pathogen
|
fifth disease aka slapped cheek syndrome
Parvovirus B19 1) slapped cheeks with lacy reticular rash * complication: fetal hydrops in newborn of pregnant mother |
|
Peds UTI Tx
|
Bactrim
Cefixime |
|
genu valgum vs genu varum in kids
|
valgum = knock knees = common, usually resolves
varum = bow legs. common up to age 3. could be Rickets or Blount's disease |
|
ethylene glycol poisoning tx
|
fomepizole antidote
telemetry monitor kidneys, possible dialysis |
|
methanol antidote
|
fomepizole
consider dialysis |
|
Ca channel blocker poisoning tx
|
secure airway
activated charcoal pressors, calcium |
|
beta blocker overdose tx
|
activated charcoal if < 1 hr post ingestion
IV fluid bolus and pressors antidote: glucagon (due to the hypoglycemia) |
|
beta blocker overdose symptoms
|
normal symptoms plus unique ones are:
1) hypoglycemia 2) bronchospasm |
|
sulfonylurea poisoning sx and tx
|
sx: hypoglycemia
tx: check blood glucose q1hr 2) give dextrose if needed 3) antidote: octreotide |
|
APAP antidote
|
NAC (N-acetylcysteine
|
|
iron poisoning antidote
|
deferoxamine
|
|
poison control phone #
|
800-222-1222
|
|
what yearly labs do you follow in Down's children?
|
thyroid (thyroid disease)
LFT CBC (looking for leukemia) hearing (many have hearing loss) |
|
colic tx
|
food sensitivity. 2wk-3mo, peaking at 6 wks in late pm. 5 S's:
swaddle sway swing suck shoosh |
|
how many exams/year ages 3-18
|
3-12 = 1/year
12-18 = 1/2 years |
|
olive shaped mass
|
pathogneumonic for pyloric stenosis
|
|
how to diagnose pyloric stenosis
|
ultrasound = string sign
|
|
congenital duodenal obstruction sign
|
Double Bubble sign on KUB (dilated loops of bowel)
|
|
how to diagnose Hirschsprung dz
and Tx |
definitive dx by rectal biopsy
can use barium enemy. tx is surgery |
|
if no passing meconium in 12-24 hours, think...
|
Hirschsprung dz
|
|
ricket's disease diagnosis
|
vitamin d deficiency
Classic characteristic changes: thickening of growth plate fraying of metaphyseal edge cupping (especially at distal radius/ulna/fibula) |
|
iron deficiency tx
|
3-6 mg/kg/day elemental Fe.
don't give with calcium |
|
chest xray findings of coarc
|
rib notching.
|
|
tetrology of fallot
|
1) large VSD
2) RVH 3) Right ventricular outflow obstruction 4) overiding aorta with respect to ventricular septum |
|
fixed split S2 heart sound
|
ASD (atrial septal defect)
|
|
where is best place to hear innocent heart murmurs
|
2nd -4th ICS along LSB
|
|
Downs syndrome heart defect
|
AV canal, VSD, TOF
|
|
Turners syndrome heart defect
|
Coarctation aorta
|
|
Marfan's syndrome heart defect
|
aortic aneurysm
|
|
Rubella syndrome heart defect
|
PDA, pulmonary stenosis
|
|
fetal alcohol heart defect
|
VSD, ASD, TOF
|
|
continuous "machinery" systolic murmur L 2nd ICS
|
PDA
|
|
PDA management
|
indomethacin IV. (an NSAID)
if no response, surgical ligation |
|
fixed and widely split S2
|
ASD
|
|
rib notching in CXR
|
pathognomic for coarctation of aorta
|
|
coarctation presentation
|
headache, blurred vision due to too much blood to brain
Also DOE, tachy, FTT |
|
physical exam findings in coarctation
|
decrease/absent femoral pulse
S4 gallop different brachial pulse between arms |
|
treatment of coarctations
|
prostaglandins to maintain patency of ductus arteriosum until surgery can be done
|
|
tetrology of fallot
|
most common R -> L shunting
1) VSD 2) right ventricular outflow track obstruction 3) right ventricular hypertrophy 4) overriding aorta |
|
age to begin growth spurt
|
girls - 9
boys - 11 |
|
peak age of growth spurt
|
boys - 13.5
girls - 11.5 |
|
Male Tanner ratings
|
1 - prepubescent testes
3 - moderate hair 4 - scrotum darkens, hair coarse does not extend to mid thigh 5 - adult |
|
tanner staging girls
|
1 - pre pubertal, no glandular tissue
3 - beginning of fatty tissue that extends beyond areola 4 = breast and areola still separate mounds 5 - smooth adult contour |
|
dehydration replacement with oral rehydration solution volumes
|
mild - 50mL/kg oral over 4 hours
moderate 100 |
|
dehydration managment with parenteral therapy
|
20mL/kg bolus in 30 minutes for severe dehydration
|
|
glasgow coma scale rating areas
|
eyes, motor, verbal
|
|
severe acute asthma attack drugs
|
epinephrine
terbutaline magnesium sulfate |
|
neonatal pneumonia treatment
|
ampicillin + gent OR amp + cefotax
|
|
pneumonia in older kids treatment
|
lots of macrolides.
also amoxicillin cefrtiax, cefotax |
|
MC pathogen in meningitis & abx used in < 1 month
|
GBS - ampicillin
E.coli and listeria - gentamicin |
|
1-3 months MC pathogen in meningitis & abx used
|
S. pneumo and N. meningitides = rocephin
|
|
when is the birthweight doubled and tripled?
|
doubled - 4 mos
tripled - 12 mos |
|
nutrition in formula
|
20kCal/oz
|
|
food transition timelines from breast milk/formula
|
4-6 mos - iron fortified cereal
6-8 - strained veggies, fruits, meats 9-12 mos = mashed, chopped, soft table foods |
|
when to wean child from bottle
|
2 years
|
|
treatment of iron deficiency
|
3mg/kg/d single dose = mild deficiency
5-6mg/kg/d in 1-2 doses = moderate/severe cases RBC transfusion in severe cases. |
|
sickle cell disease clinical manifestations
|
1) fever/infection
2) acute pain (vaso-occlusive crisis or dactylitis 3) pulm complications (acute chest syndr, asthma, pulm HTN) 4) neuro complications (stroke, cognitivie impairment 5) splenic sequestration 6) priaprism 7) impaired growth |
|
prevention of vaso occlusive crisis in sickle cell pts
|
hydroxyurea
chronic transfusions |
|
DOC for sickle cell disease
|
hydroxyurea. it increases Fetal HGB and decreases HGB S
|
|
most common cause of isolated thrombocytopenia in well children
|
immune thrombocytopenic purpura
|
|
tx of ITP
|
immune throbocytopenic purpura
prednisone IV Ig WinRho |
|
PT measures
|
factor VII in the extrinsic pathway
|
|
PTT measures
|
factors 8,9 in the instrinsic pathway
|
|
MC cancer 0-14
|
leukemia (ALL most common)
|
|
MC cancer 15-19
|
lymphoma
|
