Clin Med III Exam 1

Mild

%wt loss 3-5% General= consolable Pulse=RR BP=norm Tears=present Urine=norm Skin turgor=norm Cap refill=less than 2 sec Mucous membrane=moist Fontanelle=flat What dehydration status is this?

Severe

%wt loss >10% General=lethargic Pulse=rapid/thready BP=very low Tears=absent Urine=anuria Skin turgor=none Cap refill=over 3 sec Mucous membrane=cracked Fontanelle=sunken What dehydration status is this?

Moderate

%wt loss=6-9% General=irritable Pulse=weak/rapid BP=norm/low Tears=reduced Urine=reduced <2 cchr Skin turgor=tenting Cap refill=2-3 sec Mucous membrane=dry Fontanelle=sunken What dehydration status is this?

Arthrogryposis

(multiple joint contractures) results from chronic limitation of movement in utero that may result from lack of amniotic fluid or from congenital neuromuscular disease

Cytomegalovirus

*Most common congenital infection and the leading cause of sensorineural hearing loss, mental retardation, retinal disease, and cerebral palsy* Infected mothers transmit the virus to the fetus in 35% of cases The earlier in the pregnancy that the mother is infected, the more symptomatic the infant will be at birth Symptoms at birth are rare, but include: SGA *Microcephaly* Thrombocytopenia Hepatosplenomegaly Hepatitis Intracranial calcifications Hearing abnormalities Mortality rate is 10-15% of symptomatic newborns Trial studies for treatment continue (Ganciclovir) What maternal infection is this?

Uterine Distress

*Placental insufficiency Maternal Hypertension Preeclampsia* Oligohydramnios *Maternal drug abuse (tobacco/Cocaine) Maternal infection* Chorioamnionitis Fetal Hypoxia These are from what?

100ml/kg

0-10 kg child needs what dosing of daily IV maintenance fluid requirement?

Blood, urine, CSF evaluation Antibiotics to cover group B Strep, E. coli, gram negative rods Admit

0-28 days of age with rectal temperature > 38.0 What is the neonatal fever plan?

Hypoplastic Left Heart Syndrome

1% congenital heart defects (most common cardiac cause of death for infants in the first month of life) Failure of development MV, AV, or Aortic Arch, LV Critically ill as Ductus Arteriosus closes Blood is pumped from RV to PA and then reaches aorta through ductus arteriosus. ( Blood that reaches LA shunts through ASD to RA) Presentation = OK appearing until PDA begins to close the decompensate quickly (Tachypnea, difficulty feeding, CHF, weak pulses, Loud S2, gray color and cool mottled skin due to decreased CO.) Work Up (EKG= RVH, CXR = Cardiomegaly, pulmonary venous congestion, pulmonary edema, Echocardiography) Endocarditis Prophylaxis Limit physical activity Treatment (Prostaglandin E1= opens Ductus Arteriosus, Support BP, Surgical Correction= Norwood procedure as newborn Then bidirectional Glenn and Fontan procedures) What is this?

Total Anomalous Pulmonary Venous Return (TAPVR)

1% of all CHD Lesions (Pulmonary vein fail to connect to LA and return abnormally to Right Heart) Requires ASD for survival RA Oxygenated blood from the pulmonary vein mixed with deoxygenated blood from the body. Once in RA some shunts through ASD to body and the rest goes to RV. Children are cyanotic due to not enough oxygenated blood reaching the aorta and body. Increased WOB and cyanotic appearance. RV impulse Widely-split S2 SEM LUSB and a mid-diastolic murmur @ LLSB Treatment is surgery early in infancy (ASD is closed and pulmonary veins are rerouted to LA. ) Endocarditis prophylaxis What is this?

HIV/AIDS

1% of those living with WHAT are children under age 13, occurring perinatally Associated with altering the natural history of other diseases known to affect pregnancy, including BV, HPV, CMV, Hepatitis B & C Increases risk of pregnancy complications and perinatal infection Fetal Symptoms: Develop WHAT symptoms between 3-6 months of age in 10-25% Failure to thrive, recurrent infections, hepatosplenomegaly, neurologic abnormalities Planned C section at 38 weeks gestation is recommended Avoid breastfeeding Begin antiretroviral medications after delivery

Acute

1-2 weeks Sudden High Fever Conjuctival Erythema, Mucosal Changes, Strawberry tongue,Cervical Lympadenopathy, swollen hands and feet Irritability, abdominal pain, arthritis, Tachycardia, SOB, Giant Coronary Aneurysms Worry about MI and strokes in this section-give them aspirin only time give kids that What phase is this with Kawasaki Dz?

Kocher Criteria

1. Non-weight bearing affected side 2. Sed rate >40 3. Fever 4. WBC count >12,000 4/4 criteria = 99% chance of septic arthritis 3/4 criteria = 93% chance of septic arthritis 2/4 criteria =40% chance of septic arthritis 1/4 criteria = 3% chance of septic arthritis What criteria is this with septic arthritis?

Pulmonary Disorders

1. Respiratory Distress Syndrome 2. Transient Tachypnea of the Newborn 3. Pneumonia (Viral or bacterial) 4. Meconium Aspiration 5. Persistent Pulmonary Hypertension (also called Persistent Fetal Circulation). 6. Air Leaks 7. Congenital Malformations and Space Occupying Lesions 8. Atelectasis 9. Pulmonary Hemorrhage 10. Bronchopulmonary dysplasia What classification are these?

Anorexia

1.5% of teens Female-to-male ratio of 20:1 Unrealistic body image First event mentioned during history is a behavioral change in eating or exercise Clinical features include patient wearing oversized clothing, dry skin, bruising, depression Be nonjudgmental and develop a differential diagnosis Treatment is therapy and feeding program What is this in adolescents?

Sever's dz Boot, tulli cup recommendation, activity modification & school note (no high impact activities for the next 2-3 weeks) NSAID, RTC 3-4 weeks

10 year old male football player presents to clinic with his mother for evaluation of worsening right foot pain for the past 3 weeks. Pain gets worse with activity and the more he's on it. He is limping. Non-contributory medical history, no allergies & no medications Differential? Sever's dz, cancer, stress fracture, ankle sprain PE: Upon inspection, there are no signs of ecchymosis, erythema, or trauma. Patient has full ROM at the ankle without pain or restriction. Strength is 5/5 bilaterally. He is tender to palpation over the medial and lateral calcaneus, the plantar aspect of the calcaneus and the distal Achilles tendon. He is neurovascularly intact What is the dx and tx?

Pulmonary Valve Stenosis

10% of congenital heart defects Valvular-right at valve, subvalvular-right below it, or supravalvular Presentation Mild = Asymptomatic Mod to Severe Exertion dyspnea, easy fatiguability, RV works harder to pump blood through the pulmonary valve into the lungs SEM at Second Left Intercostal Space that may radiate to back Thrill Click that varies with respiration Work Up EKG (Normal, Right Axis, RVH) CXR (Normal) Echocardiography What is this?

Coarctation of the aorta

10% of congenital heart defects During development the aortic arch fails to develop correctly and results in the narrowing of the aortic lumen at the level of the ductus arteriosus. Male:Female 2:1 Presentation Usually no symptoms at birth. Poor Feeding, respiratory distress, shock,CHF, before 2 weeks of age. Older kids leg discomfort with exercise, headache ***Femoral Pulses weak / delayed compared to radial pulses. BP in lower extremities is < BP in upper extremities Can cause High BP in upper extremities. Sometime if CoArctation is mild the presenting symptom is found as a high blood pressure during routine physicals. S3 but no murmur Work Up EKG (RVH) CXR (Cardiomegaly, Pulm Edema, RVH, Rib Notching) Echocardiography What is this?

Atrial Septal Defect

10% of congenital heart defects Rarely Symptomatic Secundum Defect is the most common type (hole is in region of the foramen ovale. ) Left → Right Shunt Female : Male 2:1 What is this?

DKA

10-20 mL/kg NS bolus until hemodynamic stability is achieved. Then begin NS at 1.5 times maintenance level in the ED. . If [K+] is <5.5 mEq/L and patient is urinating, add 30 mEq potassium per liter (half as KCl and half as potassium phosphate). If initial [K+] is 2.5-3.5 mEq/L, add 40 mEq [K+] per liter; consider adding more if the [K+] is < 2.5 mEq/L. Begin regular insulin at 0.1 units/kg/h after IV fluid bolus (if given) is complete. Adjust dose to maintain glucose decline at 50-100 milligrams/dL/h. Do not decrease insulin infusion to <0.05 units/kg/h. Add dextrose to IV fluids when blood glucose level is < 200-250 milligrams/dL. Measure serum electrolyte levels every 2 h; measure serum glucose level every hour. What is this tx for?

Tdap

11-18, should receive THIS preferably during 11-12 year wellness visit. 19-64 previously not given THIS, give THIS to replace a Td booster at the 10 year interval. 65 and older in contact with infant less than 12 months and has not had THIS, should receive THIS regardless of interval from last Td. Td is given at the regular 10 year intervals then on Pregnancy-given with each pregnancy at 27-36 weeks optimally What vaccine is this?

1000mL + 50mL/kg for every kg over 10

11-20 kg child needs what dosing of daily IV maintenance fluid requirement?

Water Burn/Scald Safety

12 children <age 14 die from scald injuries each year. Supervision of is the most important factor Lower water heater temperature <120° F Check bathtub water temperature Keep pot handles turned inward Keep children away from heaters, hot drink/food, deep fryers etc.. What anticipatory guidance is this?

Hip flexor muscle strain Spica wrap

12 year old basketball player presents to clinic with his father for evaluation of worsening right hip pain for the past 3 months. The pain has progressed so much so that the patient is unable to run during practice or games now due to the pain. Patient is overweight, but has no other medical history. No allergies and the patient takes no medications PE: The alignment of hips, pelvis and thigh joints is symmetrical. Grossly equal leg lengths bilaterally. There are no signs of ecchymosis, erythema, or signs of infection of the right hip joint. The patient has restricted ROM in all planes of movement due to pain. Patient became tearful with manipulation of his hip joint. Tenderness over the greater trochanter, hip flexor musculature, and anterior hip crease. Unable to perform FABER/FADIR/Ober testing due to pain and guarding. Positive log roll testing. X-rays unremarkable (no acute osseous findings) Patient sent for an MRI of the right hip MRI results come back unremarkable: no labral pathology, no fractures, and no significant osseous abnormalities (looking for inflammation of the growth plate) We then ordered an ultrasound of the right lower abdomen Ultrasound results: increased echogenicity of the connective tissue in the lateral aspect of the lower abdomen indicating likely inflammation of the hip flexors and connective tissue of the anterior abdominal wall (ruled out a sports hernia) What is the dx and tx?

Score of 3, 93% have septic arthritis, could be 4/4 Discuss joint infection and need to get to hospital for followup with labs and drainage

12 year old male patient presents with his grandmother and a 5 day history of right knee pain. Denies MOI, pain came on suddenly. He is unable to weight bear on the right leg and has been using his brother's crutches to get around. What other history do you want? Does he have a fever, infection before PE: 5-10 degrees of extension & flexion. The right knee is erythematous, swollen, and warm to the touch. Patient has significant pain globally with palpation. Strength testing and special testing deferred at this time as patient was near tears during examination. Vitals are normal and the patient is afebrile X-ray: no acute osseous findings, pronounced joint effusion of the right knee Kocher score? Treatment/recommendations?

Furniture Anchors

120 children die annually and hundreds are injured Anchor furniture Place TVs on sturdy, low bases, or anchor them Install kitchen stoves with anti-tip brackets Talk to parents about this when discussing "baby proofing" and also parents of toddlers who are likely to climb and become at risk. What anticipatory guidance is this?

Salter Harris I of Distal Radius Thumb spica

13 year old female cheerleader presents to clinic with her mother for evaluation of left hand pain after falling last night at practice during a back handspring. Patient is left handed-ask if dominant arm Non-contributory medical history, no allergies & no medications Differential? Fracture, sprain, contusion, dislocation PE: Obvious swelling of the distal radius and ulna without deformity, erythema, or ecchymosis. Severely restricted motion in all planes of movement. Strength testing deferred at this time due to acute injury pattern. Patient able to move MTP joints. Upon palpation, significant tenderness over the dorsal aspect of the distal radius and ulna. Patient has tenderness over the anatomical snuffbox as well. She is neurovascularly intact What is this and what is the tx?

Osgood Schlatter Activity modification, taping, soccer note, physical therapy prescription

14 year old male soccer player presents to clinic with his parents for evaluation of intermittent, worsening, bilateral knee pain for the past 6 months. His right knee is worse than his left Non-contributory medical history, no allergies & no medications Differential? Osgood Schlatter, SCFE, ACL/meniscus tear, cancer PE: Upon inspection, there are no signs of erythema, infection, or deformity. Patient has a prominent tibial tubercle. Patient had full ROM at bilateral knee joints without pain or restriction. Strength was 5/5 and patient had pain with resisted extension of bilateral knees. Upon palpation, he was tender to palpation over the distal patellar tendon and tibial tubercle. What is the dx and tx?

Tricuspid Atresia

2% congenital heart defects Absence of Tricuspid Valve (Hypoplastic right ventricle) All venous return must cross into LA from RA. Need VSD and PDA for pulmonary blood flow. Right → Left Shunt Presentation Severe Cyanosis Sinlge S2 No Murmur Work Up EKG (LVH) CXR (Normal or enlarged cardiac silhouette) Echocardiography What is this?

CBC, blood culture, urinalysis and urine culture, CSF Chest radiograph Clinical Decision making

29-60 days of age, well-appearing What is the neonatal fever plan?

Blood, urine, CSF evaluation Chest radiograph if lung involvement suspected Empiric antibiotics Admit

29-90 days of age, toxic appearance What is the neonatal fever plan?

Hep B

3 doses recommended for all infants. Inactivated Second dose given at least 4 weeks after the first and 3rd dose must be at least 24 weeks after first dose. Birth, 2 month check, 6 month check (Example) Contraindications: allergic reaction to yeast or vaccine component such as anaphylaxis Adverse Effects: fever (1-6%) pain at injection site (3-29%) What vaccine is this for children?

Poisoning

300 children are treated daily for THIS... 2 die every day! Lock up medications and cleaners. Don't refer to medications as candy. THIS control center: 1-800-222-1222 What anticipatory guidance is this?

1250mL in 24 hours (If child is 11-20kg then1000ml + 50 ml/kg for every kg over 10kg, 1000 ml PLUS 50 x 5 = 250 ml, divide by 24hours to get the flow rate of 52mL per hour)

33 lb child is 15kg What maintenance fluid amount do they need?

6-18

3rd Hep B and 3rd IPV given between What months for kids?

12-18 months

3rd or 4th Hib, 4th PCV 13, 1st MMR, and 1st Varicella given between What months in kids?

Severe (1.2/15=8% wt loss so moderate but since dry mucus membranes, cracked lips, no urine output in 12 hrs, does not cry when stuck with needle this is severe dehydration) 1,350 mL (15X90ml/kg) 1,250 mL (For children 11-20 kg: 1000ml + 50 ml/kg for every kg over 10 1000 + 50 x 5 = 1,250) 2,600 mL (1,250 + 1,350) but max is 2,400 mL so 2,400 mL is used 300 mL 2,100 mL (subtract 2,400-300 from bolus get 2,100) 130 mL (2,100/2=1,050/8hrs=130mL per hour 1st 8 hours) 66 mL (2,100/2=1,050/16 hrs=66mL per hour 2nd 16 hours) Check electrolytes and pt status, if all well continue maintenance fluids which would be 52 mL per hour (1,250mL/24hrs=52) (Summary: Maintenance calculate by weight 1000 cc + 250cc = 1250cc over 24 hours Replacement Fluids Calculate by weight loss & symptoms 15 kg x 90 ml/kg = 1,350 ml Add two together and Adjust 1,250 +1,350= 2,600...adjust to maximum 2,400 Give Fluids 300ml bolus 1st 8 hours give ½ of what is left divided by 8 2nd 16 hours give the other half divided by 16 Stop and reevaluate child's condition)

4 year old male N/V/D x 3 days Current weight 13.8 kg, pre-illness weight 15kg Dry mucus membranes, cracked lips, no urine output in 7 hours, does not cry tears when stuck with needle. What is severity of the child's dehydration? How much replacement fluid does the child need? How much maintenance fluid does the child need? What is the total replacement fluid therapy? What size bolus is needed? What should be given in terms of total replacement fluid therapy? What should be given over 8 hours? What should be given over 16 hours? What should be done on day 2?

15-18

4th DTaP given between What months in kids?

Iron

5 stages intox: Hemorrhagic gastroenteritis, which occurs 30-60 minutes after ingestion and may be associated with shock, acidosis, coagulation defects, and coma. This phase usually lasts 4-6 hours Phase of improvement, lasting 2-12 hours, during which patient looks better Delayed shock, which may occur 12-48 hours after ingestion. Metabolic acidosis, fever, leukocytosis, and coma may also be present Liver damage with hepatic failure Residual pyloric stenosis, which may develop about 4 weeks after the ingestion. Typically, doses of more than 20 mg/kg will cause symptoms What tox is this?

School Anxiety/Avoidance

5% of children Eases by middle school Refuse to go or create situations not to go Happens only on school days Major concern in pre-adolescent Determine reason (bullying etc.) Acknowledge and send to school Be firm What is this?

Transposition of great arteries

5% of congenital heart defects The Most Common Cyanotic heart lesion in newborns. Aorta arises from right ventricle and Pulmonary artery arises from left ventricle. Without mixing death occurs quickly. Mixing can occur at an ASD, VSD, or PDA Male predominence Right → Left Shunt O2 poor blood returns to right heart and is pumped out systemically through aorta. O2 rich blood returns to left heart and is pumped back to lungs. Presentation Cyanosis Tachypnea Single S2 CHF Work Up EKG (right axis, RVH) CXR (Pulmonary vascularity and "egg on a string" shadow) Echocardiography (transposition of great arteries) What is this?

Aortic Stenosis

5% of congenital heart defects Valvular, Subvalvular, Supravalvular Presentation Fatigue, *Exertional Chest Pain*, Syncope, SOB, DOE, CHF, Asymptomatic SEM Right Second Intercostal Space Radiating to neck Increase with squatting Decrease with Valsalva, hand grip, and standing Work Up EKG (Normal, LVH) CXR (Ascending aortic dilation-bicusp leaflets can get aortic dissection/aneurysm, Aortic Knob) Echocardiography What is this?

Bulimia

5% of female college students Female-to-male ratio is 10:1 Typically seen in females who are slightly overweight with a history of dieting Nutritional, educational, and self monitoring techniques are used to increase awareness of the disorder SSRIs often used in addition to therapy Suicide rate is high (5%) What is this in adolescents?

1580mL in 24 hours (1500 ml PLUS 20 x 4 = 80 ml, If child is >20kg then1500ml + 20 ml/kg for every kg over 20kg, divide by 24 hours to get the flow rate of 69mL per hour)

53 lb child is about 24kg What maintenance fluid amount do they need?

Erb-Duchene Palsy

5th /6th CN injury, most common. Cannot abduct arm at shoulder, externally rotate the arm or supinate the forearm. Moro reflex is absent on affected side. What brachial plexus injury is this w/newborn?

Convalescent

6-8 weeks Symptoms resolved and ESR back to normal What phase is this with Kawasaki Dz?

Puberty: Girls

8-13 years of age: Thelarche Breast Budding Pubarche Pubertal fine straight pubic hair Completion of the Tanner stages should take approximately 4-5 years What is this?

Truncus Arteriosus

<1% congenital heart defects Mixing One large artery carrying blood to lungs and body. Therefore blood "mixes" from RV and LV. There is also a VSD. Presentation Cyanosis, DHF, Tachypnea, Cough, Bounding peripheral pulses SEM and Left sternal border Work Up EKG (LVH, RVH) CXR (cardiomegaly, Increased pulmonary blood flow) Echocardiography What is this?

Chest X-ray

A WHAT should be obtained on any infant having respiratory distress. A PA view is acceptable, when a lateral cannot be obtained, or in an emergent situation. This can be done by a portable unit, and results are almost immediate. Many special care nurseries have their own portable x-ray machine, and a small reading room. The results of the x-ray will determine the next step in the child's care.

Functional Constipation

A careful diet history is important to ensure that the child is consuming adequate dietary fiber and maintaining an adequate fluid intake. If diet change alone is ineffective, medications may be required Medications: Osmotic stool softeners such as milk of magnesia, lactulose, or polyethylene glycol solution (MiraLax). Stimulant laxatives such as standardized extract of senna fruit (Senokot syrup, ExLax) Disimpactants such as hypertonic phosphate or saline enemas, mineral oil (2-3 mL/kg/d), and nonabsorbable osmotic agents such as polyethylene glycol (MiraLax, 1 g/kg/d) and milk of magnesia (1-2 mL/kg/d) Stool softeners should thereafter be given regularly in doses sufficient to induce two or three loose bowel movements per day Behavioral Modification: Regular toilet sittings A few minutes on awakening in the morning and after meals Ensuring proper foot placement while sitting on the toilet Addressing any underlying fears about toileting by the child Recurrence of encopresis is common and should be treated promptly to eliminate the fecal impaction and avoid the cycle of impaction, soiling, and retentive behaviors What is this tx for?

Transient tachypnea of the newborn

A common disease in newborns that presents with tachypnea, retractions, expiratory grunting, and occasionally hypoxia. Appears shortly after birth, and usually resolves within 72 hours. usually presents in near-term or full-term infants. This disease is usually self-limiting with little morbidity. Pathophys: At birth, the neonate lung switches from Cl- (fluid) secretion to Na+ (fluid) absorption. Neonates do not develop the ability to absorb fluids until late gestation. If this ability is delayed, the infant is unable to clear lung fluids. Can occur even in the face of a mature lung. Infants should clear up to 35% of lung fluid before birth An additional 30% is cleared during active labor as a result of mechanical transpulmonary pressures and catacholemines. The last 35% is cleared postnasaaly as a result of active crying and breathing. Infants born by cesarean do not undergo the transthoracic forces of labor and are at greater risk of developing TTN. Respiratory distress Tachypnea (quiet) Alar flaring Grunting Retractions Hypoxia Cyanosis - severe cases only What is this?

Deep tendon reflexes

A few beats of ankle clonus and an upgoing Babinski reflex may be normal. What neuro exam is this?

Antihistamines

A five year-old female is brought to the emergency department for evaluation of altered level of consciousness after mother found an empty pill bottle in the child's possession. The bottle was unlabeled and was taken by the child from her grandmother's purse, and may have contained a number of medications. It is unclear how many pills are missing. Physical examination reveals a well-developed, well-nourished female in minimal distress. Vital signs include HR 140 beats/min, Respirations 24/minute, temperature 100.4F (38C), pulse ox 98% RA. HEENT examination reveals flushed face and dry mucosa. Cardiac examination reveals tachycardic rate, regular rhythm, no R/M/G. Lungs CTA B. No wheezing/stridor/rhonchi. Extremities reveal dry, red skin. Neurologic examination reveals agitation with the child reaching to grab for items in front of her, while nothing is seen for her to grab. Otherwise, no focal deficits are seen. What overdose is this?

Cerebral Palsy

A group of disorders that effects a persons ability to move Chronic Non-progressive Impairment of muscle tone, strength, coordination, or movements arising before or after birth Higher incidence in premi and twin births What is this?

Oxygen SABA Nebulized anticholinergic Aminophylline Magnesium sulfate

A high concentration of WHAT should be given by face mask to achieve oxygen saturation of >90% High doses of WHAT given either by nebulizer or via a metered-dose inhaler with a spacer In severely ill patients with impending respiratory failure, IV β2-agonists may be given A WHAT may be added if there is not a satisfactory response to β2-agonists alone A slow infusion of WHAT may be effective, but it is important to monitor serum levels WHAT given intravenously or by nebulizer is effective when added to inhaled β2-agonists, and is relatively well tolerated For patients with respiratory failure, it is necessary to intubate and institute ventilation What is this with acute severe asthma tx?

Casein

A large protein similar to gluten that is difficult for humans to digest. It makes up 40% of the human milk proteins (whey 60%) Formula, Cow milk, and Goat milk is 80% THIS However, Goat milk has less alpha and more beta. Resulting in less allergic reaction! What is this in formula?

Motor vehicle crash/injury

A leading cause of preventable death in children CAR SEATS reduce the risk of fatal injury by >50% Must be Age/size- appropriate Must be installed properly Children should never sit in front of airbags What anticipatory guidance is this?

Ears Nose Mouth and palate

A newborn's eyelids may be edematous, making the eye exam difficult. If the lights are dimmed, the infant may open their eyes and allow for the examiner to elicit a red reflex. If this is not present, an ophthalmologist should examine the infant before hospital discharge. WHAT should be inspected for size, position and rotation. Malposition may be associated with syndromes and any pits associated with hearing loss. Tympanic membranes are difficult to see due to vernix , but canal patency should be documented. The WHAT may be slightly pressed down, but patency should be observed by placing a mirror or shiny metal surface under it to observe fogging. The WHAT are inspected next. If the infant cries, the entire palate may be observed. A tongue blade may be necessary to visualize completely. Lips and tongue are observed at this time. Occasionally, natal teeth are present. If loose remove!

Intussusception

A previously healthy infant 3-12 months of age develops recurring paroxysms of abdominal pain with screaming and drawing up of the knees Vomiting and diarrhea occur soon afterward (90% of cases), and bloody bowel movements with mucus appear within the next 12 hours (50%) The child is characteristically lethargic between paroxysms and may be febrile The abdomen is tender and often distended A sausage-shaped mass may be palpated, usually in the upper mid abdomen In older children, sudden attacks of abdominal pain may be related to chronic recurrent THIS with spontaneous reduction What clinical presentation is this?

Acetaminophen

A six year-old female is brought to the emergency department with a four-day history of fever. This illness began with low grade fever with upper respiratory symptoms, but today the child had onset of nausea and vomiting with jaundice. The patient's mother has treated her with around the clock doses of ibuprofen and acetaminophen. Physical examination reveals a cachectic female in mild distress. Vital signs include HR 120 beats/min, Respirations 24/min, temp. 102.2F (39C). HEENT examination reveals mild scleral icterus. TM clear. Pharynx with mild erythema, mucosa dry. Cardiopulmonary examination is unremarkable. Abdomen examination reveals soft, flat abdomen with minimal tenderness diffusely noted. No guarding or rebound. Bowel sounds x 4 intact. No hepatosplenomegaly. Remainder of examination is unremarkable. What overdose is this?

Vernix caseasa

A term newborn infant's skin is covered with WHAT, a greasy yellow-white material.

Scarlet Fever

AKA Scarletina Rash that accompanies strep throat fine, sandpaper-like Pastia's lines: dark red in creases papules

Otitis Media with Effusion (OME)

AKA serous otitis media, chronic otitis media Persistent fluid, no infection or other S/S Primarily first 2 years of life, peaks at one year TM dull, retracted, often with fluid level or bubbles Tympanogram - membrane mobility May last weeks to months, usually resolves spontaneously If persists > 3-6 months - audiogram to ck hearing If hearing loss, can interfere with speech development Myringotomy tubes What is this?

Physical Abuse

Abdominal trauma, although rare, is the second leading cause of mortality from WHAT Abdominal computed tomography is the preferred test in suspected abdominal trauma Any infant or very young child with suspected THIS-related abdominal trauma should be evaluated immediately Hollow viscus injury occurs more commonly with inflected trauma than accidental, and injury to solid and hollow organs occurs almost exclusively with THIS

Atrioventricular Canal Defects

Abnormal development of endocardial cushion tissue, failure of septum fusion to endocardial tissue. Left → Right Shunt Large hole in center of heart. Tricuspid and mitral valves aren't formed as normal valves. What is this?

Status Asthmaticus

Abnormalities of Gas Exchange Ventilation-to-perfusion mismatch Hypoxia Lung Mechanical Abnormalities Incomplete exhalation and formation of positive end-expiratory pressure are the hallmarks Pressure leads to decreased lung static compliance Circulatory Effects During expiration, elevated intrathoracic pressures decrease right-sided filling Vigorous inspiration augments right ventricular filling and shifts the intraventricular septum leftward to cause a conformational change in the left ventricle (LV), diastolic dysfunction, and incomplete LV filling Leads to pulsus paradoxus What pathophys is this for?

Long QT Syndrome

Abnormality of ventricular repolarization May lead to ventricular tachycardia, torsades de pointes, sudden cardiac death Symptoms Syncope or near syncope with exercise Often asymptomatic Diagnosis ECG Treatment Cardiology referral and work up Return to sports is determined by presentation, underlying cause, and need for pacemaker What is this found on a PPE?

Polyhydramnios

Abnormally increased amount of amniotic fluid Complicates 1 to 2 percent of pregnancies *Associated with premature labor, maternal discomfort, and respiratory compromise* Associated with diabetes, immune or nonimmune hydrops fetalis, multiple gestations, trisomy 18 or 21, and major congenital anomalies Outcomes that have been reported to be increased with hydramnios include *cesarean delivery rate, birthweight > 4000 g, perinatal mortality rate* Because the etiologies of hydramnios are so varied, hydramnios treatment also varies and is tailored in most cases to the underlying cause What is this?

Hyperparathyroidism

About 67% of women with primary WHAT during pregnancy experience complications: Nephrolithiasis Hyperemesis Pancreatitis Muscle weakness Cognitive changes Hypercalcemic crisis may occur, especially postpartum About 80% of fetuses experience complications of maternal WHAT, including: Fetal demise Preterm delivery Low birth weight Newborns have hypoparathyroidism that can be permanent Hypocalcemia in the infant can present with tetany even 2-3 months after delivery

Physical Abuse

Accidental injury Dermatologic disorders Mongolian Spots Erythema multiforme-target like lesions Stevens-Johnson Syndrome Severe diaper dermatitis Hematologic disorders ITP Leukemia Vitamin K deficiency Hemophilia Genetic disease Ehler-Danlos syndrome Henoch-Schonlein purpura Infection Sepsis Staphylococcal Scalded skin syndrome Congenital Syphilis Osteomyelitis Metabolic disorders Osteogenesis imperfect Copper deficiency Glutaric aciduria type I Intracranial vascular abnormalities What DDx is this for?

DTaP

Acellular pertussis vaccines with INACTIVATED components Booster of pertussis to prevent adolescent and adult cases in hopes of reducing spread to infants. DTaP is given during primary series initiation. 5 doses are give at 2, 4, 6, between 15-18 months and again between 4-6 years of age. In one year Whooping cough infected 300,000 people and killed 7,000. CI: Do not use in children who developed encephalopathy within 7 days of previous dose Defer in those with progressive neurological disorders such as spasm, uncontrolled seizures, encephalopathy until status is stable Precautions: High fevers, persistant inconsolable crying or shock-like state within 48 hours of previous dose Seizures within 3 days of previous dose Guillain-Barre syndrome less than 6 weeks after previous dose Severe or moderate illness with or without a fever Adverse Effects: Local reaction, fever, mild systemic effects Substantial local reactions at injection site What vaccine is this with children?

N-acetylcysteine (NAC)

Activated charcoal may be considered in patients who present within 2 hours of acetaminophen overdose A serum acetaminophen level (mcg/mL) drawn at 4 hours after a single acute ingestion can be plotted on the Rumack-Matthew nomogram to determine the need for treatment If the serum level is at or above the treatment line, the patient should be treated with a standard course of oral or intravenously administered WHAT Patients who require administration of THIS should be admitted to the hospital

Epiglottitis

Acute life threatening emergency Caused by H. influenzae type B (rare because of vaccine) Usually age 1-5 yrs Toxic appearance, high fever, muffled voice, breathing difficulty , unable to swallow saliva; tripod stance X-ray lateral neck - thumb sign

Formula

Adv: Available if breastfeeding is not an option Easier to assess volume intake DisAdv: Will never be as nutritional as breast milk Is cow's milk based or plant based, or both Additives No passive immunity Increased respiratory and GI infections Increased asthma, allergies, obesity, infections... No breast cancer reduction risk for mom What is this associated with?

Breastfeeding

Adv: COLOSTRUM!! -passive immunity via immunoglobulin, decrease incidence of respiratory and GI infections, high in protein. Natural Gold standard There is no better formula Probiotics Higher cognitive development Immunity Decreases risk of maternal PPS Decrease incidence of asthma, allergies, obesity, infections... Decreased risk of breast cancer for mom DisAdv: Medicines pass via milk, labor intensive What is this associated with?

Prenatal risk factors

Advanced maternal age (>35 years of age) Age less than 16 years Tobacco use Alcohol and/or substance abuse Family history - prematurity Genetics 50% IUGR infants are identified before delivery Obstetric History Race Poor maternal nutrition Drug abuse Infections Polyhydramnios Oligohydramnios Placental Abnormalities -I.e. abruption-cocaine is number one reason Meds: Narcotics, Warfarin, methotrexate What are these that complicate delivery?

Allergic Rhinitis

Affects 10 to 30 percent of children and adults in the United States and other industrialized countries Signs and Symptoms: Presents with paroxysms of sneezing, rhinorrhea, nasal obstruction, and nasal itching, postnasal drip, cough, irritability, and fatigue are other common symptoms What is this?

Fetal Alcohol Syndrome (FAS)

Affects 30%-40% of offspring of mothers Seen with daily intake of 3 or more ounces of alcohol No safe level of alcohol intake has been established for pregnancy Features of the syndrome include: Short stature Poor head growth (may be postnatal in onset) Developmental delay Midface hypoplasia characterized by a poorly developed long philtrum, narrow palpebral fissures, and short nose with anteverted nares Cardiac anomalies and neural tube defects are commonly seen Genitourinary tract anomalies are frequent Neurobehavioral effects in FAS include: poor judgment and inappropriate social interactions, and lack of stranger anxiety in toddlers What is this?

Height, weight, head circumference Heart Pulses Chest and lungs

After vital signs are recorded, the infant's WHAT are measured. This information is plotted onto a growth chart based on the child's gestation age, using a Ballard scoring chart. Many times, the obstetrician will have an estimate of gestational age by dates before the infant is delivered, but the scoring still needs to be done. This is usually done by the nursery nurses. Physical examination of the newborn is a very complete, head to toe exam. As in all examinations of young infants, do listening first. The WHAT should be auscultated for at least 30 seconds listening for murmurs and regularity. WHAT are checked in ALL extremities, and graded as 2+/4+ and equal. Note any very strong or bounding pulses. WHAT re auscultated next, to assess equal and full breath sounds, and to note any adventitious sounds. This is the time to observe work of breathing, and any chest asymmetry.

Substance Abuse

Age of first use is decreasing (<12 years old) Trends: Smoking commonly starts in adolescent years (90%) Alcohol use unchanged since 1980s Marijuana and stimulant medications had declined since the 1980s, but are on the rise again Inhalant use decreasing "Club drugs" (Ecstacy and Rohypnol) have risen sharply in upper income groups Anabolic steroids use has increased markedly in adolescent boys seeking to enhance athletic performance Provider should be nonjudgmental and supportive Include: Type of drugs Frequency Timing Circumstances Outcomes of substance use What is this in adolescents?

Teratogens

Alcohol Carbamazepine Cyclophosphamide Diethylstilboestrol Isotretinoin Lithium Methimazole Methotrexate Mycophenolate Mofetil Penicillamine Phenobarbital Phenytoin Tetracyclines Valproic Acid Warfarin ACE inhibitors These are known human what?

Meningococcal

All 11-12 year olds SHOULD be vaccinated with the conjugate vaccine. 16 year olds booster of meningococcal conjugate vaccine Adults SHOULD-first-year college student in residence hall, military recruit, in an outbreak zone, HIV, asplenia, microbiologist, HIV, complement deficiency If the first dose of was given at age 16, no booster is needed All 16-23 year olds (16-18 is optimal) MAY be vaccinated with serogroup B vaccine All adolescents and young adults SHOULD receive the serogroup B if there is an outbreak, complement component deficiencies, or anatomic asplenia (including sickle cell) CI and Precautions: Contraindicated with a known severe allergic reaction to component or rubber latex Discuss risk with those with a history of Guillain-Barre Both formulations can be given in immunosuppressed Adverse effects: Generally well tolerated Local redness, swelling, or induration Injection site pain and irritability Fever, headache, fatigue, malaise, chills, anorexia, vomiting, seizures What is this vaccine?

Hib (Haemophilus influenza type b)

All children younger than 5 years old Unvaccinated older children and adults with certain medical conditions People who receive a bone marrow transplant Infants 2 through 6 months of age should receive either: A 3-dose series of Hib PRP-T as ActHib®, Hiberix®, or Pentacel® (2, 4, 6 months) A 2-dose series of Hib PRP-OMP as PedvaxHib® (2, 4 months) You can administer the first dose as early as age 6 weeks. CDC recommends a booster dose of any licensed conjugate Hib vaccine at age 12 through 15 months. Administer the booster dose at least 8 weeks after the most recent vaccination. The booster dose will be dose 3 or 4 depending on vaccine type used in the primary series. Contraindications and Precautions You should not administer vaccines to: A person who has ever had a severe allergic reaction (e.g., anaphylaxis) after a previous dose A person who has a severe allergy to any vaccine component A person younger than 6 weeks You may administer vaccines, if you and the parent or patient deem the benefits of vaccination to outweigh the risks, to: A person who has a moderate or severe acute illness with or without fever Adverse Effects-5-30% swelling, redness, or pain at injection site. Systemic reactions are rare What vaccine is this for children?

Sexual Abuse

All practitioners should have access to a rape kit, which guides the practitioner through a stepwise collection of evidence and cultures This should occur in an emergency department or clinic where chain of custody for specimens can be ensured The most experienced examiner (pediatrician, nurse examiner-SANE nurse-sexual assault nurse examiner, or child advocacy center) is preferable 120 hours: For cases of adolescent assault or rape that occurred in the preceding 120 hours, most states require for legal purposes that a rape kit be used If the history indicates that the adolescent may have had contact with the ejaculate of a perpetrator within 120 hours, a cervical examination to look for semen or its markers (e.g., acid phosphatase) should be performed according to established protocols Children are most likely to have physical findings within 72 hours of most recent assault Special attention needed for: Injury Blood Semen Injuries to the oral mucosa, breasts, thighs Few findings are diagnostic of sexual assault Acute, unexplained lacerations to vaginal vault Ecchymosis of the hymen, posterior fourchette or anus Complete transection of the hymen Unexplained anogenital scarring *Pregnancy in an adolescent-abuse unless proven otherwise* What PE is this for?

Cushing's Syndrome

Almost all patients with THIS have a pituitary adenoma (Rare in childhood) ACTH secretion is increased more than that of cortisol, suggesting that the adrenal cortex is relatively unresponsive to excess ACTH The relative activity of the enzymes involved in cortisol biosynthesis does not change and, therefore, the production and excretion of cortisol precursors are increased proportionately The corticotroph adenoma cells respond to decreases in serum cortisol concentrations by increasing ACTH secretion and to increases in serum cortisol concentrations (or other glucocorticoids such as dexamethasone) by decreasing ACTH secretion What is this?

Intubate (Due to low functional residual capacity, infants and neonates are more likely to require early initiation of noninvasive ventilation or endotracheal intubation A temporary intraosseous line should be placed if IV access cannot be rapidly obtained for resuscitation fluids and medications A central venous line should be considered in patients with hemodynamic instability, particularly if they require ongoing resuscitation and infusions of vasoactive medications Subclavian and internal jugular lines are preferred for more accurate and consistent central venous saturation and pressure monitoring)

Altered mental status Significant hemodynamic instability Inability to protect the airway Poor respiratory effort High work of breathing Poor gas exchange Patients in shock who will require surgery or other interventions requiring general anesthesia What should you do with managing this acutely ill pediatric pt?

Fever in neonates and young infants

Although most neonates (younger than 28 days of age) and young infants (29 to 90 days of age) with fever have a benign viral illness, the goal of the evaluation is to identify those children who are at high risk for serious bacterial illness (e.g., bacteremia, urinary tract infection, meningitis, bacterial gastroenteritis, or pneumonia), and who therefore require empiric antimicrobial therapy and possibly hospitalization The young febrile infant may demonstrate few, if any, interpretable clues to the underlying illness The limitations of the history and physical examination in neonates and young infants with fever traditionally have led to an aggressive laboratory evaluation, even for patients who were previously healthy, are well-appearing, and have no focal infection In the past, most of these patients have been admitted to the hospital for antibiotic treatment pending negative cultures What is this for?

Severe Asthma (THE tweeners)

An incomplete response to treatment is defined as the persistence of mild wheezing or dyspnea and a PEFR or FEV1 between 50% and 69% of predicted If the patient demonstrates a good response to treatment over a reasonable period of time and close follow-up can be arranged, discharge home may be appropriate Patients who continue to have an incomplete response should be admitted to a medical ward What is this?

Congenital Adrenal Hyperplasia

Androgen excess is present in all patients and manifests with broad phenotypic variability: Severe virilization of the external genitalia in neonatal girls (e.g., 46,XX DSD) Labial fusion, urogenital sinus, enlargement of the clitoris, or other evidence of androgen action Growth rate and skeletal maturation are accelerated and patients appear muscular Pubic hair appears early (often before the second birthday), acne may be excessive, and the voice may deepen. Excessive pigmentation may develop Boys with classic CAH usually present with life-threatening adrenal crisis in the first few weeks of life (salt-wasting crisis) A simple-virilizing genotype manifests with precocious pseudo-puberty and advanced bone age in early childhood What clinical presentation is this?

B

Animal reproduction studies have been performed and have revealed no evidence of impaired fertility or harm to the fetus. Prescribing information should specify kind of animal and how dose compares with human dose.orAnimal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus during the first trimester of pregnancy, and there is no evidence of a risk in later trimesters Examples include many antibiotics, such as penicillins, most cephalosporins, and macrolides What category is this with FDA system?

C

Animal reproduction studies have shown that this medication is teratogenic (or embryocidal or has other adverse effect), and there are no adequate and well-controlled studies in pregnant women. Prescribing information should specify kind of animal and how dose compares with human dose or There are no animal reproduction studies and no adequate and well-controlled studies in humans Approximately two thirds of all medications are in this category It contains medications commonly used to treat potentially life- threatening medical conditions, such as albuterol, zidovudine, and calcium-channel blockers. What category is this with the FDA system?

Potential Child Abuse

Any infant with bruises (especially head, facial, or abdominal), burns, or fractures Any infant or child younger than age 2 years with a history of suspected "shaken baby" head trauma or other inflicted head injury Any child who has sustained suspicious or known inflicted abdominal trauma Any child with burns in stocking or glove distribution or in other unusual patterns, burns to the genitalia, and any unexplained burn injury Any child with disclosure or sign of sexual assault within 48-72 h after the alleged event if the possibility of acute injury is present or if forensic evidence exists These are medical emergencies of what?

Urinary Tract

Approach to pt 3-36 mons: What is the most common site of bacterial infection among febrile infants and young children The prevalence of UTI is highest among girls and warrants urinalysis and urine culture in all females age 3 to 24 months with fever ≥39ºC (102.2ºF) and no source Among boys, UTI is increased in uncircumcised compared with circumcised male infants with fever, with the greatest incidence in infants younger than three months of age This low evidence of UTI among circumcised boys supports the practice of not routinely obtaining a catheterized urine specimen for culture in febrile, circumcised boys over six months of age Evaluate for UTI in uncircumcised males ≤12 months and circumcised males ≤6 months

Honeymoon Period

Approximately 3-6 weeks after diagnosis, most school-children and adolescents experience a partial remission or WHAT Temporary decrease in the insulin dose during this period is necessary to avoid severe hypoglycemia This period will typically last 3-6 months The remission tends to last longer in older children, but is rarely complete and never permanent Start low dose and titrate over a few months

SABA ICS Theophylline

Approximately one-third of asthmatic patients who are pregnant improve during the course of a pregnancy, one-third deteriorate, and one-third are unchanged It is important to maintain good control of asthma because poor control may have adverse effects on fetal development Compliance may be a problem because there is often concern about the effects of antiasthma medications on fetal development The drugs that have been used for many years in asthma therapy have now been shown to be safe and without teratogenic potential WHAT, WHAT, and WHAT are the meds If an OCS is needed, it is better to use prednisone rather than prednisolone because it cannot be converted to the active prednisolone by the fetal liver There is no contraindication to breast-feeding when patients are using these drugs

Denver Developmental Screening

Assesses Four Domains Gross motor Fine motor Personal-social Language What assessment screening tool is this?

Bayley Scales of Infant Development

Assesses three areas using "play" tasks Motor Language Cognitive Used for ages 0-3 Takes 60 minutes What assessment screening tool is this?

Eye/Ear

Assessment includes palpation for cartilage thickness, then folding the pinna forward toward the face and releasing it. The examiner notes the rapidity with which the folded pinna snaps back away from the face when released. In very premature infants, the pinnae may remain folded when released. In such infants, the examiner notes the state of eyelid development as an additional indicator of fetal maturation. What is this with ballard scoring and PE?

Neonate Fever

Associated symptoms (respiratory, gastrointestinal) and behaviors (feeding, irritability, activity) Exposures to sick contacts (siblings, babysitters, day care) Any previous illness, or antibiotic use Birth history, including perinatal factors that suggest an increased risk of vertically transmitted infection such as maternal fever; the mother's group B streptococcus status and prophylaxis; maternal history of sexually transmitted infections such as herpes simplex virus, gonorrhea, and chlamydia; prolonged rupture of membranes, and the infant's nursery course What hx is this for?

Group B Strep (GBS)

Asymptomatic colonization occurs in 30% of women Approximately 50% of infants exposed to the organism in the lower genital tract will become colonized Early onset: Septicemia and septic shock Pneumonia Meningitis Late onset occurs in infants older than 6 days Screening and treatment have decreased number of infections What maternal infection is this?

Acquired (juvenile hypothyroidism)

Autoimmune (lymphocytic) thyroiditis (Hashimoto's thyroiditis) Thyroidectomy or radioiodine therapy for Thyrotoxicosis Thyroid cancer Irradiation to the thyroid Thyrotropin deficiency Isolated Associated with other anterior pituitary hormone deficiencies TRH deficiency due to hypothalamic injury or disease Medications Iodides (1) Excess (e.g., amiodarone) (2) Deficiency Lithium Cobalt Idiopathic What is this?

Addison's Disease

Autoimmune destruction of the adrenal cortex Findings include: Hyperpigmentation Salt craving Postural hypotension Fasting hypoglycemia Episodes of shock during acute crisis Lab findings include: Low cortisol Hyponatremia Hyperkalemia Elevated renin activity What is this?

Phenylketonuria

Autosomal recessive disease, primarily affecting the brain 1:10,000 live births Result from a defect in the hydroxylation of phenylalanine to form tyrosine Affected infants are normal at birth, but if left untreated, phenylketonuria exhibit severe mental retardation (IQ<30), hyperactivity, seizures, a light complexion, and eczema Screening test as newborn Positive newborn screen will show high concentration of amino acids Plasma phenylalanine value of greater than 360 is consistent with the diagnosis and requires further testing Based on finding elevated serum phenylalanine and an elevated phenylalanine/tyrosine ratio in a child on a normal diet In THIS, serum phenylalanine levels are persistently elevated above 1200 μM (20 mg/dL) on a regular diet, with normal or low serum levels of tyrosine, and normal pterins What is this?

Fetal Surveillance

Available techniques employed to forecast fetal well-being focus on fetal biophysical findings that include heart rate, movement, breathing, and amniotic fluid production These findings are used to perform antepartum fetal surveillance to evaluate and prevent fetal death and avoid unnecessary interventions The 2 main methods of fetal surveillance are the biophysical profile or modified biophysical profile and Doppler ultrasound Patients that may benefit from fetal surveillance include those with complaints such as decreased fetal movements, who carry fetuses with intrauterine growth restriction, or with medical or fetal complications that put them at risk for intrauterine death or severe morbidity What is this?

Hypertrophic Cardiomyopathy

Avoid dehydration Avoid competitive athletics Increase diastolic filling time Β-blockers Ca++ channel blockers Surgical myectomy ICD-internal cardiac defib in patients with highest risk of SCD Severe hypertrophy Documented ventricular dysrhythmias Resuscitated SCD *Family Hx of HCM with SCD* What is this tx for?

Cerebral Edema

Avoid high dose insulin therapy Judicious fluid management Early clinical recognition Avoid administration of sodium bicarb Treatment: Mannitol, 0.5-1 g/kg IV bolus or 10 mL/kg of 3% saline over 30 min Fluid restriction Appropriate airway management and vent What is this avoiding?

Dental Health

Avoid refined starch! Avoid sugar! Teeth care Brush 2 x daily SMALL amt. of toothpaste FLOSS (Start around age 7) Dental check up at age 3 then every 6 months What anticipatory guidance is this?

Cephalohematoma

BORDERS ARE LIMITED BY SUTURES. RESOLUTION IS SLOW, BUT USUALLY REQUIRES NO INTERVENTION. Neither this or caput succedaneum should be confused with intracranial epidural hematoma w/shift from trauma What localized edema of the head is this present after birth?

Toilet Training

Begin 18-30 months Factors that effect refusal : early training parent-child conflict constipation Prerequisites to training: bowel and bladder regularity sphincter control Most can control urination by day at 2.5 years and at night by 4 years psychological ability Desire!!!!! What is this?

Antileukotrienes

Block cys-LT1-receptors and provide modest clinical benefit in asthma Less effective than ICS in controlling asthma and have less effect on airway inflammation, but are useful as an add-on therapy They are given orally once or twice daily and are well tolerated What tx is this with asthma?

Sickle Cell Crisis

Bone and joint issues are the most common manifestations of THIS A THIS (also known as a vaso-occlusive episode or VOE) is triggered when the abnormally-shaped blood cells block small blood vessels that supply the body's tissues Avascular necrosis (AVN) is the loss of bone tissue due to a restriction of blood supply In children with THIS, AVN usually affects the hip. The first sign can be a limp or pain in the groin. AVN can cause persistent hip pain that can last for several months. In severe cases, it may be necessary for the child to be non weight bearing for some time VOEs-vasoocclusive episode happen acutely, but they lead to chronic issues over time What is this?

B2

Breast bud stage; elevation of breast and papilla as a small mound, and enlargement of areolar diameter What Tanner stage is this?

Ampicillin Aminoglycoside Cephalosporin

Broad-spectrum coverage should be given to the ill neonate and include WHAT (100-150 mg/kg/d divided every 12 h) plus an WHAT (3-4 mg/kg/dose every 24 hours based on gestational age at birth) or third-generation WHAT (cefotaxime 100 mg/kg/d divided every 12 h)

Intestinal Atresia

CBC, serum electrolytes, liver function, and amylase should be measured to identify dehydration, pancreatitis, and other complications Radiographic features include dilated loops of small bowel and absence of colonic gas Double bubble sign Contrast radiographs In over 10% of patients with intestinal atresia, the mesentery is absent, and the SMA cannot be identified beyond the origin of the right colic and ileocolic arteries The ileum coils around one of these two arteries, giving rise to the so-called Christmas tree deformity on contrast radiographs Surgery is mandatory after appropriate hemodynamic stabilization, NG suction, and broad spectrum antbiotics Postoperative complications include short bowel syndrome (SBS) in 15% and small bowel hypomotility Overall mortality has been reported at 8%, with increased risk in low-birth-weight and premature infants Consider cystic fibrosis if associated with the small intestine What is this?

Shingles

CDC recommends Shingrix for adults 50 years and older. Even people who have had THIS or previously got Zostavax can be vaccinated with Shingrix to prevent THIS and the complications caused by the disease. Those with prior history should still receive vaccine. The weakened virus from the Varicella (chicken pox) vaccine does live dormant in neurons just like a natural infection, but it is less likely to reactivate. Adults who only had Varicella immunization should still receive a vaccine. If you had Zostavax in the recent past, you should wait at least eight weeks before getting Shingrix If you test negative for immunity to Varicella Zoster, you should get Chicken Pox vaccine Contraindications-history of anaphylactic reaction to gelatin, neomycin, or other component to vaccine, primary or acquired immunodeficiency such as leukemia, lymphoma, bone marrow neoplasm or lymphatic neoplasm, HIV, high dose corticosteroids, pregnancy Zoster vaccine can be given in persons in remission from leukemia once they are 3 months post chemo treatment Side effects-myalgias, fever What vaccine is this?

4-5

Cannot throw ball, jump, ride a bike Won't interact or separate by age 4 Cannot use me or you properly Extreme diff. dressing, sleeping, toileting Overly aggressive or timid Inability to stay on task Cannot give first & last name by age 5 These developmental warning signs occur during what years?

Complex

Carbs are awesome, as long as they are WHAT?! Simple carbs (soda, juice, etc.) are bad!!! Induce osmotic diarrhea Juice is a junk food!

Chest Pain (Always get a full H and P. Especially Family Hx Has there been a recent illness or viral infection? Has there been syncope? When does it occur? With or without activity? Positional-pericarditis? Associated with respirations?)

Cardiac: Mitral valve prolapse (MVP)-palpatations-PVC, PJC Aortic stenosis Pulmonary stenosis Tachydysrhythmias-fast rapid funny heart beats Dilated cardiomyopathy Myocarditis Pericarditis Rheumatic heart disease Aortic dissection Kawasaki disease NonCardiac: Respiratory Reactive airway disease Pneumonia Pneumothorax Pulmonary embolism Gastrointestinal GERD Esophagitis Foreign body ingestion Musculoskeletal Costochondritis Slipping rib syndrome Precordial catch Chest deformities These cause what in peds?

B2 Agonists

Cause increased intracellular cyclic adenosine monophosphate (AMP), which relaxes smooth-muscle cells and inhibits certain inflammatory cells, particularly mast cells. Mode of Action Reverse and prevent contraction of airway smooth-muscle cells by all known bronchoconstrictors Inhibition of mast cell mediator release Clinical Use usually given by inhalation to reduce side effects Long-acting include salmeterol and formoterol LABAs have replaced the regular use of SABAs, but LABAs should not be given in the absence of ICS therapy because they do not control the underlying inflammation Side Effects Muscle tremor and palpitations What tx is this with asthma?

Physical Abuse

Certain radiologic findings are strong indicators of WHAT Examples are metaphyseal "corner" or "bucket handle" fractures of the long bones in infants, spiral fracture of the extremities in non-ambulatory infants, rib fractures, spinous process fractures, and fractures in multiple stages of healing Skeletal surveys in children aged 3 years or younger should be performed when a suspicious fracture is diagnosed

Salicylates

Charcoal binds THIS well and should be given for acute ingestions Mild poisoning may require only the administration of oral fluids and confirmation that the salicylate level is falling Moderate poisoning involves moderate dehydration and depletion of potassium Fluids must be administered Sodium bicarbonate Potassium Severe toxicity Major fluid correction of dehydration is required Potassium supplementation Sodium bicarbonate Renal failure or pulmonary edema is an indication for hemodialysis (see below) Acetazolamide should not be used. What tx is this for?

Head

Check for cephalohematoma (a swelling over one or both parietal bones that is contained within suture lines) and caput succedaneum (edema of the scalp over the presenting part that crosses suture line) Check for the presence and size of the fontanelles The anterior fontanelle varies from 1 to 4 cm in any direction The posterior fontanelle should be less than 1 cm Sutures should be freely mobile, but are often overriding just after birth What exam is this w/the newborn?

Skeleton

Check for obvious anomalies such as absence of a bone, club-foot, fusion or webbing of digits, and extra digits Examine for hip dislocation by attempting to dislocate the femur posteriorly and then abducting the legs to relocate the femur noting a clunk as the femoral head relocates Look for extremity fractures and for palsies (especially brachial plexus injuries) and evidence of spinal deformities (eg, scoliosis, cysts, sinuses, myelomeningocele) Arthrogryposis (multiple joint contractures) results from chronic limitation of movement in utero that may result from lack of amniotic fluid or from congenital neuromuscular disease What exam is this?

See child within 24 hours

Child is 3-6 mo old (unless fever occurs within 48 h after a diphtheria-tetanus-pertussis vaccination and infant has no other serious symptoms) Fever exceeds 40°C (especially if child is < age 3 y) Burning or pain occurs with urination-can go up to kidneys and get septic Fever has been present for > 24 h without an obvious cause or identified site of infection Fever has subsided for > 24 h and then returned Fever has been present > 72 h These indicate what?

See child immediately

Child is < age 3 mo with fever > 38°C Fever is > 40.6°C (105F) Child is crying inconsolably or whimpering Child is crying when moved or even touched Child is difficult to awaken Child's neck is stiff Purple spots or dots are present on the skin-try to blanch them Child's breathing is difficult and not better after nasal passages are cleared Child is drooling saliva and is unable to swallow anything A convulsion has occurred Child has sickle cell disease, spenectomy, human immunodeficiency virus (HIV), chemotherapy, organ transplant, chronic steroids Child acts or looks "very sick" These indicate what?

Child Abuse

Child presents for medical care with significant injuries, no history of trauma, especially in infant or toddler age The history provided by the caregiver does not explain the injuries The history of the injury changes significantly over time A history of self-inflicted trauma does not correlate with the child's developmental abilities There is an unexplained or unexpected delay in seeking medical care Multiple organ-systems are injured, including injuries of various age-especially ones that can't walk yet The injuries are pathognomic for THIS

Rheumatic Fever

Children 6-15 years Immunologic reaction that is a delayed sequela of group A beta-hemolytic streptococcal infection of pharynx. Usually 2-6 weeks after infection What is this?

Antihistamines

Children are more sensitive to the toxic effects of THIS than are adults Findings include: Agitation/confusion/delirium Fever Red dry skin Dry mouth/mucous membranes Mydriasis Urinary retention QRS widening and myocardial depression associated with severe intoxication Toxicity occurs after ingestion of 3-5 times the usual daily dose The non-sedating agents are associated with less toxicity

Munchausen syndrome by proxy

Children may present with the signs and symptoms of whatever illness is factitiously produced or simulated The child can present with a long list of medical problems or often bizarre, recurrent complaints Persistent doctor shopping and enforced invalidism (e.g., not accepting that the child is healthy and reinforcing that the child is somehow ill) are also described in the original definition of WHAT They may be actually ill or, more often, are reported to be ill and have a normal clinical appearance Among the most common reported presentations are: Recurrent apnea Dehydration from induced vomiting or diarrhea Sepsis when contaminants are injected into a child Change in mental status Fever Gastrointestinal bleeding Seizures

1

Children should exercise for at least how many hours a day? Include: Aerobic Biking, running, dancing, tag soccer, basketball... Muscle-strengthening Gymnastics, jungle gym, climbing Bone-strengthening hopping, jumping, running, gymnastics, tennis, basketball...

In-Toeing

Childs foot turns in more than expected during walking and running Clinical Presentation Usually a concern for parents or grandparents Severe in-toeing may cause excessive tripping Physical Examination Observe foot progression through walking Measure hip rotation. Prone position with knee flexed, measure internal hip rotation. Excessive internal rotation (> 65) with limited external rotation indicates increase femoral ante-version Measure tibial torsion (thigh - foot angle) Observe foot posture Evaluation for possible neuromuscular disorders What is this?

150/100

Chronic HTN If the woman is not known to have chronic hypertension, then initiation of antihypertensive therapy in pregnant women is indicated only if the blood pressure is sustained at or above WHAT mm Hg or if there is evidence of end-organ damage Treatment of hypertension has not been demonstrated to improve pregnancy outcomes The goal is a modest reduction in blood pressure and avoidance of severe hypertension

Convalescent

Chronic cough lasts for weeks What stage of pertussis is this?

Pediatric

Clavicle fractures Supracondylar humerus fractures Forearm fractures Femur fractures Toddlers fractures Tibia fractures These are common fractures of what?

Scoliosis

Clinical Presentation Curvature is typically identified on school screening exam or routine physical Idiopathic is typically not painful Significant pain suggests a secondary cause Physical Examination Mild curvature is typically not noticed on standing Forward bend test - most sensitive clinical exam. Look for elevation of rib cage and prominence of lumbar paravertebral muscle mass Assess trunk and lower extremities for skin lesions, cavus feet, limb-length discrepancy, abnormal joint laxity Diagnostic Tests Full length PA and lateral spine radiographs with patient standing known as a "THIS series" Cobb angle to quantify curvature - always measured at the most severe part of curve What is this?

Osteosarcoma

Clinical Presentation Pain at rest that increases with activity Limp Parents may be concerned that their child has a sprain, arthritis, tendonitis, or just growing pains There may be a history of trauma Swelling Systemic symptoms (such as fever, weight loss, and night sweats) are rare Physical Examination Mass - A palpable mass may or may not be present; the mass may be tender and warm. Increased skin vascularity over the mass may be visible Decreased range of motion - Involvement of a joint should be obvious on physical examination Lymphadenopathy - Involvement of local or regional lymph nodes Respiratory findings - Auscultation is usually uninformative unless the disease is extensive Diagnostic Tests Plain radiographs, AP and lateral of suspected area Pathognomic "sunburst" appearance Can be purely osteolytic, purely osteoblastic, or a mix Codmans triangle may be present which is elevation of the periosteum Extension of the tumor through the periosteum may result in a so-called sunburst appearance (~60% of cases) An image of the entire bone and the adjacent joint should be obtained to assess for skip lesions or joint involvement What is this?

Osgood-Schlatter Disease

Clinical Presentation Pain over tibial tubercle Worsened by running, jumping and kneeling activities Pain with prolonged sitting Physical Examination Extreme tenderness over insertion of patellar tendon on tibial tubercle Usually bilateral but often on side is more symptomatic Knee motion is usually not restricted Kneeling is painful Inspection reveals an elevated and/or prominent tibial tubercle Diagnostic Tests AP and lateral radiographs of the knee may be normal or show soft tissue swelling. Small heterotopic ossification may be seen anterior to tibial tubercle What is this?

Slipped Capital Femoral Epiphysis (SCFE)

Clinical Presentation Pain which is exacerbated with activity, typically in anterior proximal thigh May be referred to distal thigh and rarely to the knee Physical Examination Loss of hip internal rotation - very sensitive and specific exam Assess internal rotation with hip at 90⁰ flexion Affected leg is approximately 1-3 cm shorter Patient typically walks with affected leg externally rotated Diagnostic Tests AP and frog-lateral of the pelvis confirm diagnosis What is this?

Juvenile Rheumatoid Arthritis (JRA)

Clinical Presentation Pain, swelling, joint stiffness Pauciarticular (4 or fewer joints) Irritability, lethargy, and reluctance to play Age of onset is typically younger than 4 Girls are affected 4 times more than boys Usually begins in single joint: knee, ankle, wrist, or fingers Uveitis is most likely to develop in this type of JRA, and a positive ANA and high ESR Polyarticular (5 or more joints) Symmetric involvement of knees, wrists, fingers, and ankles More common in girls Onset is usually age 1-3 years for seronegative forms Onset is in adolescence for seropositive forms Systemic onset is usually 4-9 years and is associated with spiked fevers, polyarthralgias, myalgias, maculopapular rash and high ESR What is this?

Genu Valgum

Clinical Presentation Parental concern is presenting complaint Physical Examination Measure inter-malleolar distance (IM). Distance between medial malleoli with legs extended with medial femoral condyle touching. IM is dependent on leg length Diagnostic Tests Radiographs are not necessary but should be considered if valgus is > 15-20⁰. Weight bearing x-rays will accurately measure tibio-femoral angle and can evaluate for skeletal dysplasia Treatment Observation is the treatment of choice. Spontaneous correction occurs 99% of the time What is this?

Genu Varum

Clinical Presentation Parental concern is usually the presenting complaint Physical Examination Quantify with goniometer or by measuring the inter-condylar (IC) distance Diagnostic Tests Radiographs are appropriate if child is under 25th percentile for height or varus is relatively severe. Tibial depression with tibial metaphyseal-diaphyseal angle of 20⁰ indicates infantile tibial vara Treatment Physiologic - no treatment Infantile tibia vara - bracing can be successful, but after 30-36 months tibial osteotomy may be required What is this?

Sever's Disease

Clinical Presentation Posterior heel pain and limping related to activity Physical Examination Tenderness to posterior aspect of calcaneus Diagnostic Tests Radiographs are not diagnostic, but may be helpful to rule out other pathology Treatment Short term activity modification Shoe modification with ¼" heel lift or heel cushion Achilles tendon stretching may be helpful What is this?

Calcaneovalgus Foot (Flatfoot)

Clinical Presentation Usually asymptomatic Occasionally child will report activity related pain in the feet, ankles & legs Physical Examination Heel is in valgus alignment Prominent medial malleolus Foot rotated outward in relation to the leg Hyper mobile midfoot May have Achilles contracture Diagnostic Tests Radiograph usually not indicated. Weight bearing, AP, lateral, and oblique films are indicated to evaluate rigid deformity What is this?

Pertussis

Clinical diagnosis Cough lasting at least 14 days with one of the following: Paroxysmal cough Post-tussive emesis Inspiratory whoop Cough lasting 14 days in the setting of a known outbreak Lab diagnosis Isolated B pertussis Clinical case with PCR findings or linkage to a lab confirmed case. CXR - non specific perihilar infiltrates with atelectasis. What Dx is this for?

Meconium aspiration syndrome

Clinical presentation: Cyanosis Expiratory Grunting Alar Flaring Intercostal Retractions Tachypnea Barrel Chest (air trapping) Rales/Rhonchi Yellow/green staining What is this for?

Hypoglycemia

Common in DM type 1 Related to excess insulin in elation to the serum glucose concentration Symptoms include: Neuroglycopenia Headache, visual disturbance, confusion, irritability, seizures Catecholamine response Tremors, tachycardia, diaphoresis, anxiety Older children present with: Hunger Weakness Shakiness Sweating Drowsiness (at an unusual time) Headache Behavioral changes Nausea and vomiting Palpitations Paresthesia Infant symptoms include: Feeding difficulty Pallor Hypotonia Hypothermia Episodes of apnea Bradycardia Depressed level of consciousness seizures What is this?

Poisoning

Common items: Family members medications (Analgesics) Cleaning or polishing solutions-acetone Cosmetics-isopropyl alcohol Personal care products Fatal: Medications Analgesics Antihistamines Sedative/hypnotics Drugs of abuse Fumes/gases/vapors Carbon Monoxide-fix it by pumping full of O2-get ABG Hydrocarbons Caustic ingestions These agents are often implicated in more serious what?

Antireflux surgery (Nissen fundoplication)

Complications of reflux esophagitis or chronic GERD include feeding dysfunction, esophageal stricture, and anemia Barrett esophagus, a precancerous condition, is uncommon in children, but it may occur in patients with an underlying primary diagnosis that offers high risk for GERD WHAT may be considered in a child with GERD who: Fails medical therapy Is dependent on persistent, aggressive medical therapy Is nonadherent to medical therapy Has persistent, severe respiratory complications of GERD

Poisoning

Complications: General Coma Long differential, including CVA, trauma, asphyxia, meningitis Direct Toxicity Hydrocarbon ingestion - direct pulmonary toxicity Caustics/button batteries - dysphagia, epigastric pain, oral mucosal burns Metabolic acidosis MUDPILES Dysrhythmias Prolonged QT, Widened QRS, Sinus bradycardia Gastrointestinal Symptoms Emesis, nausea, abdominal cramps, diarrhea Seizure Uncommon, but life threatening when they occur (MUDPILES: Methanol, carbon monoxide Uremia Diabetes mellitus Na - (Cl + CO2 ) = Anion Gap Normal is 4-16 Paraldehyde, phenformin Isoniazid, iron Ethanol, ethylene glycol Salicylates, starvation, seizures) What complications is this from?

Reactive Airway Disease

Condition resulting in wheezing Used synonymously for asthma (Incorrectly) Often a term used to describe wheezing in infants and small children in whom a diagnosis is suspected but not yet confirmed What is this?

Laryngeal Papillomatosis

Condyloma often increases in size and area during pregnancy due to relative immune suppression Transmission of HPV from mother to infant is very rare but manifests as WHAT?

Congenital Hypothyroidism

Congenital Aplasia, hypoplasia, or maldescent of thyroid Embryonic defect of thyroid development Inborn errors of thyroid hormone synthesis, secretion, or recycling (due to autosomal recessive mutations) Iodide transport defect Organification defect (1) Mutation in iodine peroxidase (2) Mutation in pendrin: Pendred syndrome, associated with congenital sensorineural deafness Coupling defect Iodotyrosine deiodinase defect Abnormal iodinated polypeptide (thyroglobulin) Inability to convert T4 to T3 Maternal antibody-mediated (inhibit TSH binding to receptor) TSH receptor defect Thyroid hormone receptor defect In-utero exposures Radioiodine Goitrogens (propylthiouracil, methimazole) Iodine excess Iodide deficiency (endemic cretinism) What pathophys is this for?

Clubfoot (talipes equinovarus)

Congenital deformity with 4 components: 1) Plantar flexion of the ankle 2) Adduction of the heel 3) High arch at midfoot 4) Adduction of the forefoot Clinical Presentation Appears as if infant could walk on the top or dorso-lateral aspect of foot Physical Examination Test muscle function and sensation Truly idiopathic is not fully reducible by passive manipulation caused by intra-uterine molding rather than true can placed in normal position Diagnostic Tests Radiographs are not necessary What is this?

Venous Hum

Continuous Louder when upright Ages 3-6 What innocent cardiac murmur is this?

Nutrition

Cook at home Involve kids in grocery shopping , packing their lunch, and cooking Teach kids the nutritional value of foods, and how to read food labels Have healthy snacks available (Teach them what healthy snacks are) Limit portions Encourage WATER Eat more fruits and veggies Top cereal with fruit Create a food collage or animal Make frozen fruit kabobs and fruit smoothies with spinach or kale At the store, let your kids pick out new fruits or veggies to try. Add veggies and fruits to baked goods Keep fresh fruit and veggies available as snacks Puree veggies and sneak them in It takes children 10 tries before they accept a new food Offer new food when your child is hungry Serve new foods with favorite foods Limit caloric beverages (Only Water!) Eat the food yourself; children imitate Have your child help to prepare foods. Limit snacks. What anticipatory guidance is this?

Umbilical cord coiling

Cord vessels spiral through the cord UCI-is the no. of complete coils divided by the cord length in cm Antenatal UCI has the lower sensitivity than the measurement postpartum Hyper coiling is linked with fetal demise, IUGR, and intrapartum hypoxia Abnormal UCI has been related to trisomies and single umbilical artery What is this?

Systemic Corticosteroids

Corticosteroids are used intravenously (hydrocortisone or methylprednisolone) for the treatment of acute severe asthma A course of OCS (usually prednisone or prednisolone 30-45 mg once daily for 5-10 days) is used to treat acute exacerbations of asthma; no tapering of the dose is needed Approximately 1% of asthma patients may require maintenance treatment with OCS using lowest dose necessary to maintain control Side effects Truncal obesity, bruising, osteoporosis, diabetes, hypertension, gastric ulceration, proximal myopathy, depression, and cataracts Monitor bone density What tx is this with asthma?

Hand-Foot-Mouth Dz

Coxsachie virus Incubation 3 - 6 days Symptoms Low grade fever, URI symptoms, ± abdominal pain Ulcerative pharyngitis (herpangina) Vesicular/pustular lesions on palms, soles What is this?

Separation Anxiety

Criteria: Intense fear when separated from parent > 4 weeks Worse when tired, sick or hungry Usually eases at *18 months* Treatment: behavioral therapy, psychotherapy Don't fuss- distract and say good-bye Tears are for the parent- they stop Practice What is this?

Caput Succedaneum

Crosses the sutures Usually no intervention What localized edema of the head is this present after birth?

Dyskinetic Cerebral Palsy

Damage to the Basal Ganglia variable movement that is involuntary (outside of their control). These involuntary movements are especially noticeable when a person attempts to move. Dyskinetic movements can be: Twisting and repetitive movements - known as dystonia Slow, 'stormy' movements - known as athetosis Dance-like irregular, unpredictable movements - known as chorea. What is this?

Ataxic Cerebral Palsy

Damage to the Cerebellum Inability to coordinate voluntary muscular movements. Poor Balance Lack of coordination Wide based Gait Inability to walk a straight line What is this makes up 15% of cases?

Spastic Cerebral Palsy

Damage to the Cortex muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech and gait May be accompanied by a seizure disorder and mental retardation Prognosis worse than for other types Brain does not send correct signal nothing wrong with limbs just the brain What is this makes up 75% of cases?

Ultrasound

Dates by WHAT accurate to within 7 days if done <14 weeks and is used to change the EDD *If <22 Weeks with >10 days difference between Ultz/LMP then adjust EDD *Third Trimester dating grossly inaccurate 21-30 days off *Ballard Score Post Nataly- Accurate to within 2 wks (14d)

Depression

Decline in school performance Excessive school absences or cutting class Frequent or persistent psychosomatic complaints Changes in sleeping or eating habits Difficulty in concentrating or persistent boredom Signs or symptoms of depression, extreme stress, or anxiety Withdrawal from friends or family or change to a new group of friends Severe violent or rebellious behavior or radical personality change Conflict with parents Sexual acting-out Conflicts with the law Suicidal thoughts or preoccupation with themes of death Drug and alcohol abuse Running away from home These are indicators for what?

K

Deficiency: Bleeding Overdose: Hemolytic anemia, jaundice, hyperbilirubinemia Functions: blood clotting Source: Leafy Greens Avocados Liver Broccoli Brussels Sprouts Cabbage Cauliflower Also Made by bacteria in the intestine What vit is this in kids?

E

Deficiency: Impossible without starvation Overdose: Usually Nontoxic Severe: nausea, Increased bleeding time, anemia, Low birth weight infants Abdominal cramps, headache, diarrhea Function: Prevents cell damage, antiox Sources: Leafy greens Seeds Beans Nuts Egg yolk Liver What vit is this in kids?

A

Deficiency: Mild: night blindness, diarrhea, impaired vision Severe: Eye inflammation, keratinization of skin and eyes. Blindness. Overdose: Mild: nausea, irritability, blurred vision. Severe: growth retardation, hepatomegaly, alopecia, bone pain, high CSF pressure Functions: Skin and mucous membrane health Resistance to infection Night vision Bone and tooth development Prevents cancer Source: Carrots Leafy greens Sweet potatoes Pumpkins Squash Apricots Cantaloupe Egg yolk Liver Peaches Mango Broccoli Bell Peppers What vit is this in children?

D

Deficiency: Rickets in children Osteomalacia in adults. Overdose: Mild: nausea, weight loss, irritability. Severe: mental and physical growth retardation, azotemia, movement of calcium from bones into soft tissues, hypercalcemia, kidney stones, cardiac arrhythmia Physiology: Hardens bones and teeth Increases calcium absorption Source: Almond Milk Fish oil Mushrooms Egg yolk Sunlight What vit is this in kids?

Young maternal age

Defined as age less than 16 years Increased incidence of: Preterm births Small for gestational age infants Post-neonatal mortality Child abuse Subsequent maternal unemployment Poor maternal educational achievement Due to behavioral/social factors What pregnancy is this in?

Very Low Birth Weight

Defined as infants that weigh less than 1500 g at birth 1% of all births, 50% of neonatal deaths 200 times more likely to die in the neonatal period What is this?

Advanced Maternal Age

Defined as maternal age over age 35 Increased incidence of: Nondisjunction Event Failure either of two homologous chromosomes to pass to separate cells during the first meiotic division, or of the two chromatids of a chromosome to pass to separate cells during mitosis or during the second meiotic division As a result, one daughter cell has two chromosomes or two chromatids, and the other has none Trisomy-majority do not come from this age group-generally born to younger women less than 35 What pregnancy is this?

Functional Constipation

Defined as two or fewer stools per week or passage of hard, pellet-like stools for at least 2 weeks Their history reveals: No significant neonatal constipation Onset at potty training Pass large caliber stools Retentive posturing present May have encopresis Retention of feces in the rectum results in encopresis in 60% of children with constipation About 2% of healthy primary school children have chronic retentive constipation The ratio of males to females may be as high as 4:1 What is this?

Low Birth Weight

Defined as weighing less than 2500 grams Associated with a high number of the neonatal and infant mortality rates Make up 6-7% of all births, associated with 70% of all deaths Prematurity is the most common cause of LBW in developed countries What is this?

Cerebral Palsy

Depending on the type and severity of the motor deficits, associated neurologic deficits or disorders may occur: Seizures in up to 50% Mild mental retardation in 26% Severe retardation in up to 27% Other disorders are present and found in varying degrees: Disorders of language Disorders of speech Disorders of vision and hearing Disorders of sensory perception What are these associated neurologic deficits with?

3 Year

Development: Imitates Shows affection and concern for friends Takes turns Understands "mine" and "his" or "hers" Shows a wide range of emotions Separates easily from mom and dad Dresses and undresses self Follows instructions with 2 or 3 steps Can name most familiar things and understands "in," "on," and "under"... Says first name, age, and sex and can name a friend Talks well enough for strangers to understand most of the time Carries on a conversation using 2 to 3 sentences Can work toys with buttons, levers, and moving parts Plays make-believe with dolls, animals, and people Does puzzles with 3 or 4 pieces Copies a circle with pencil or crayon Turns book pages one at a time Builds towers of more than 6 blocks Screws and unscrews jar lids or turns door handle Patient Education/anticipatory guidance: Limit juice and milk Feeding/nutrition Dental- Brush 2x daily, see dentist Bike helmet Smoke detectors Poison control Outdoor safety Read to child Potty Training What visit is this?

6 month

Development: Movement- Rolls both directions, sits, supports weight on legs & bounces, reaches, transfers objects, rocks back on legs into pseudo crawling position Vision- full color, distance, anxiety around strangers, upset over lost toys Language- laughs, blows bubbles, imitates sounds Social- Recognizes faces, plays, responds to emotions, likes to look at self in mirror, responds to talk with babbles Patient Education/anticipatory guidance: New foods Teething-6 months first tooth Safety: Smoking, water, sleep, falls, baby proof home, sunburn Stimulation/Interaction What visit is this?

4 month

Development: Movement- Rolls front to back, supports weight on legs, reaches, transfers objects, shakes toys, holds head steady. Vision- full color, distance matures, recognizes a bottle Language- responds to name, understands tone, babbles Social- Smiles, plays, imitates, responds to affection Patient Education/anticipatory guidance: New foods Sleep changes-growth spurt-eat every 2 hours then sleep again or sleep longer bc belly bigger and not hungry t/out the night Safety: Smoking in home, water, sleep, falls, baby proof home... Stimulation/Interaction What visit is this?

12 month

Development: Movement- gets to sitting position, crawls, pulls up, walks along furniture, stands w/o support, first steps. Small- pincer grasp, bangs cubes Language- responds to requests. Dada, mama, bye-bye, uh-oh, imitates sound Cognitive- identifies objects, uses objects correctly, finds hidden object, follows simple directions Social/Emotional- stranger anxiety, cries for parent, tests parents, has fears, plays games like pat-a-cake/peek-a-boo Patient Education/anticipatory guidance: Diet- introduce cup, finger feeding, choking foods, nutrition Safety- poison control, mobility Behavior management Stimulation- reading Get rid of baby bottle and pacifier What visit is this?

2 month

Development: Movement- intentional, less reflexive. Raises head and chest off bed. Hands to mouth, bats objects, grasps toys. Vision- watches face, tracks objects, begins eye hand coordination. Hearing/Speech- babbles, turns head to sound. Social- smiles, "plays" with people Patient Education/anticipatory guidance: Diet, feeding Stimulate child with play/toys/songs etc. Sleep Safety Roll-over/fall safety Car seat Bottle tooth decay Smoking in home What visit is this?

1 Month

Development: Movement- reflexive, jerky Vision- sees 18-24", eyes cross Hearing- turns to voice Social- smile and facial expressions but not social Patient Education/anticipatory guidance: Safety- car seat, hot water, 2nd and 3rd hand smoke, rolling off table, sleep position, crib safety (No fluffy things) Warnings- fever, when to call Feeding advice and elimination advice Any parent questions? What visit is this?

9 month

Development: Movement- rolls over, gets to sitting position, picks up small things, pulls to stand, crawls or scoots, points at things. Vision- full color, distance, stranger anxiety, upset over lost toys Language- laughs, blows bubbles, imitates sounds Social- Fear of strangers, has favorite toys, copies gestures, plays peek-a-boo, looks for hidden things-hide teddy bear Patient Education/anticipatory guidance: Eating-finger foods-can eat anything you are eating and mush it up-can be spicy if they can handle it Teething Safety: Smoking, water, sleep, falls, baby proof home, sunburn Stimulation/Interaction What visit is this?

4-5 Year

Development: Movement- running, climbing, ride a bike, throws. Copies shapes, draws a person, may copy letters. Language- understands speech, multi-part commands, tells stories. Cognitive- puzzles, fantasy play, counts, learns colors. Social- cooperative play, wants to please, negotiates, independent Emotional- develops fears (monsters), sees self as a person with feelings What visit is this?

24 month

Development: Movement- walks, runs, kicks ball, climbs, scribbles, builds blocks, feeds self Language- knows names of people and objects; uses short sentences. Follows directions. Cognitive- sorts shape and color, pretend play Social- imitates behavior, enjoys company Emotional- increased independence, defiant behavior, separation anxiety improves Immunizations: Hep A #2, DTaP #4, "Make-up" immunizations Patient Education/anticipatory guidance: Further child proofing Prepare for the terrible two's Talk about toilet training- not ready yet Most frequent concern is discipline Diet management Remind to continue to use car seat What visit is this?

18 month

Development: Temper tantrums Stranger fear/clingy Shows affection Plays pretend Points to tell what he wants Says 20+ words Says and shakes head "no" Knows what things are for; ex. telephone, brush, spoon Can follow 1-step commands Walks alone and may go up steps Drinks from a cup Eats with a spoon Patient Education/anticipatory guidance: Water safety Poison control number Child proof home Car seat Sunburn prevention Nutrition Choking prevention Physical Activity (TV) Teeth brushing Smoke detectors Discipline Gun safety What visit is this?

15

Development: Vocabulary of three to six words Points to one+ body parts Understands simple commands ("bring me the ball"). Walking has improved Crawls up stairs-stair safety Self finger feeding Drinks only from a sippy cup Recognizes self in mirror Indicates what they want by pulling, pointing, grunting etc. Finds hidden object Scribbles Patient Education/anticipatory guidance: Diet- introduce reg cup-water, finger feeding, choking foods Safety- poison control, mobility Behavior management Stimulation- reading Limit Juice and Milk Feeding issues Tooth brushing Car seat Smoke Detectors Water Safety Choking Prevention No pacifier or bottle Parental concerns? What visit is this?

6-12 Year

Developmental Milestones Motor- Strength and coordination, organized activities (sports, dance) Cognitive- School progress reports. Language- higher order thought process, complex instructions, expressing self, abstract reasoning and logical thought Social/Emotional- home is important, friends and group involvement too What visit is this?

Gesell's Developmental Theory

Developmental age may differ from chronological age Children go through stages, each at his own pace Development is affected by internal and external factors Internal: Genetics, temperament, personality, learning style, and physical and mental growth External: Environment-not given opportunity to hold baby bottle at an orphanage, family, parenting style, culture, health conditions, and early experiences with peers and adults. Motor: Body activity, eyes, and hands. Hygiene: Eating, sleeping, elimination, bathing, and dressing. Emotion: Affect, crying, assertion, fears, and anger. Interpersonal: Mother-child, child-child, and group play. Play/pastimes. Interests: reading, music, radio... School: Adjustment, classroom demeanor, academic ability. Ethics: Response to punishment /praise; sense of good/bad, & truth Philosophical view: Time, space, thought, war, death, and deity. What assessment screening tool is this?

Intrauterine Growth Restriction

Deviation in expected growth pattern Fetal growth stops and over time declines to less than the 5th percentile of growth for gestational age Also present when growth proceeds slowly, but with absolute size remains less than the 5th percentile Not all small infants have IUGR Several etiologies: Fetal Conditions: Fetal Infections Primordial dwarfing syndromes Chromosomal abnormalities Congenital malformation syndromes Placental Causes: Congenital infections Placental tumors Chronic abruption placentae Twin-to-Twin transfusion syndrome Placental insufficiency Maternal causes: Chronic Hypertension Diabetes Reduced nutritional intake Alcohol/tobacco/drug use Uterine constraint What is this?

Malnutrition

Diagnosis is clinical Labs determine the severity: Chemistries H & H (Hemoglobin & hematocrit) Parasitology UA HIV What eval is this for?

126 200 200 6.5

Diagnosis of DM: Based on four glucose abnormalities Fasting serum glucose > WHAT mg/dl Random venous plasma glucose > WHAT mg/dl with symptoms of hyperglycemia Abnormal glucose tolerance test with a 2-hr post prandial serum glucose concentration of >WHATmg/dL HgbA1C > WHAT Diagnosis of impaired glucose tolerance FBS 101-125 mg/dl 2-hour plasma glucose following oral glucose tolerance test (OGTT) 140-199 mg/dL

School Refusal

Diagnostic Criteria: Somatic complaints with no physical cause (Usually Abdominal Pain) Symptoms in the morning then disappear Missed 5+ days of school for vague symptoms Treatment: Treated as an Anxiety Disorder What is this?

Osteosarcoma

Diagnostic Tests Bone scan is important in evaluating for the presence of metastatic or multifocal disease Lesions found on bone scan should be evaluated with CT CT scan of the primary lesion and a CT scan of the chest (high resolution) should be obtained CT of the primary lesion helps delineate the location and extent of the tumor and is critical for surgical planning CT of the chest is more sensitive than plain film radiography is for assessing pulmonary metastases MRI of the primary lesion is the best method of assessing the extent of intramedullary disease. MRI also identifies associated soft-tissue masses and skip lesions Tumor type will be assessed by biopsy "There is no issue without tissue" The characteristic feature is the presence of osteoid in the lesion. Electron microscopy occasionally may be required to reveal this process. Stromal cells may be spindle-shaped and atypical, with irregularly shaped nuclei What is this for?

Developmental Dysplasia of the Hip (DDH)

Diagnostic Tests In neonates radiographs are of limited benefit. Physical exam is usually sufficient for diagnosis but can be confirmed with ultrasound 4-8 months - radiographs are helpful Treatment Goal of treatment is to reduce hip joint and maintaIn it while the acetebulum develops and hip stabilized If DDH is detected at 0 - 3 months - Pavlik Harness. This holds hips flexed and abducted. Must be worn full time At 3- 9 months Pavlik harness may be less successful and spica cast may be required What is this for?

DKA

Diagnostic evaluation Hyperglycemia (200 mg/dL to > 1,000 mg/dL) Arterial pH < 7.25, serum bicarbonate < 15 mEq/L, elevated serum/urine ketones Elevated BUN (prerenal azotemia) Leukocytosis (left shift as stress response or related to infection) What Dx is this for?

6 months

Discuss at every pre-post natal visit until mom stops For health- It is the best nutrition! Passive immunity! Reduced ear & respiratory infections, obesity, and chronic disease such as asthma and allergies. Recommend- Exclusive breastfeeding for the first WHAT then continue breastfeeding supplemented with baby food till at least the first birthday. 1 in 3 women who plan to breastfeed quit in the first 6 weeks! Offer support or refer to a lactation specialist!

Breastfeeding

Discuss at the newborn visit and every visit until mom stops . For health- It is the best nutrition! Passive immunity! Reduced ear & respiratory infections, obesity, and chronic disease such as asthma and allergies. Recommend- Exclusive THIS for the first six months then continue THIS supplemented with baby food till the first birthday. 1 in 3 women who plan on THIS quit in the first 6 weeks! Offer as much support as you can or refer to a lactation specialist!

Galactosemia

Disorder of carbohydrate metabolism Autosomal recessive disorder with an incidence of approximately 1:40,000 live births caused by almost total deficiency of galactose-1-phosphate uridyltransferase (GALT) Accumulation of galactose-1-phosphate causes hepatic parenchymal disease and renal Fanconi syndrome Galactose is found in milk and all foods that contain milk occurs when an enzyme, called 'galactose-1-phosphate uridyl transferase' (GALT) is either missing or not working properly Results in inability to break lactose down into glucose What is this?

Galeazzi

Displaced fracture of distal radius with dislocation of ulna or fracture of the distal ulna physis What forearm fracture is this found in kids?

Percentage of Weight Loss (First step calc replacement fluids-determine initial healthy body weight first pre illness weight) (Second step: Make sure your calculations are correct based on patient signs and symptoms Clinical signs may even be better indicators of hydration status than weight loss Clinical signs are especially useful when a pre-illness weight is unknown)

Divide the weight lost in kg by the pre-illness weight, then multiplying by 100 Ex. 10-kg baby who has lost 1 kg 1/10= 10% dehydrated This is classified as severe dehydration Every 1 kg of weight lost is equivalent to 1 L of fluid loss Pt. will need an additional 1000ml of fluid in addition to maintenance fluid calculations What is this determining?

DHA

Docosahexanoic acid (An omega-3 fatty acid) Naturally found in human milk Dietary sources include fatty fish like salmon and mackerel Can be synthesized in the liver from alpha-linoleic acid (ALA), another fatty acid found in flaxseeds, canola oil, and walnuts. What is this in formula?

12

Does not crawl Drags one side of body > 1 month Cannot stand w support No reach for hidden objects Uses no single words Does not point These developmental warnings occur during what month?

6

Does not roll over Does not support weight on legs Does not reach Doesn't transfer objects No laughing No imitation (sound or expressions) Does not play These developmental warnings occur during what month?

Anticipatory Guidance

Done at Well Child Exams Injuries are the main risk to life and health of children Preventative care and guidance at patient visits is effective Drowning Poisoning Bike Helmets Firearms Furniture Anchors Exercise Nutrition Car Seats Burns Etc... What is this?

Patent Ductus Arteriosus

Ductus Arteriosis allows blood flowing from pulmonary artery to aorta during fetal life. PDA is failure of normal closure of this shunt after birth. 5 to 10% of congenital heart defects. Left → Right Shunt Oxygenated blood shunted from descending aorta to pulmonary artery. Common in premature infants. Rare in full term babies. What is this?

Cardiopulmonary

During fetal life, the placenta offers low resistance to blood flow. In contrast, the pulmonary arterioles are markedly constricted and there is high resistance to blood flow in the lungs. Therefore, the majority of blood entering the right side of the heart travels from the right atrium into the left atrium across the foramen ovale (right-to-left shunt). In addition, most of the blood that makes its way into the right ventricle and then pulmonary arteries will flow from the pulmonary artery into the aorta through the ductus arteriosus (right-to-left shunt). At birth, two events affect the cardiovascular and pulmonary system: (1) the umbilical cord is clamped, removing the placenta from the maternal circulation (2) breathing commences As breathing commences, the pulmonary vascular resistance falls below that of the systemic circuit, resulting in a reversal in direction of blood flow across the ductus arteriosus and marked increase in pulmonary blood flow Right-to-left shunting disappears completely by 8 hours Functional closure of the ductus arteriosus begins shortly after birth The ductus arteriosus usually remains patent for 1-5 days Although flow through the ductus arteriosus usually is gone by 5 days of life, the vessel does not close anatomically for 7-14 days Similarly, the left atrial pressure rises above that of the right atrium, functionally closing the flap of the foramen ovale In the normal newborn, pulmonary vascular resistance and pulmonary arterial pressure continue to fall during the first weeks of life as a result of demuscularization of the pulmonary arterioles Adult levels of pulmonary resistance and pressure are normally achieved by 4-6 weeks of age *It is at this time typically that signs of pulmonary over-circulation associated with left-to-right shunt lesions (VSD or atrioventricular septal defect [AVSD]) appear* What changes are these at birth?

DKA

Dx: Essential: glucose, electrolyte, venous blood gas analysis, phosphate level, test for urinary ketones Optional: Mg level, Ca level, serum osmolality, serum ketone test, CBC, lactate level What Dx is this for?

Hypertrophic Cardiomyopathy

ECG Normal Q waves or ST segment changes II, III. aVF, V5, V6 Increased septal mass Graded exercise testing (GXT) LVOT obstruction Ischemia Dysrhythmia-go into V fib before sudden cardiac death Cardiac catheterization Angina Syncope + GXT Resuscitated SCD Echocardiography Assymetrical septal hypertrophy What is this?

GBS or gram-negative enteric organism Penicillin

Early-onset sepsis is usually caused by WHAT or WHAT Prevention of early onset neonatal GBS infection has been achieved with intrapartum administration of WHAT given more than 4 hours prior to delivery (see next slide)

Kwashiorkor

Edema of the extremities "Moon" face Swollen abdomen Dry, cracked skin The weight is on the growth chart. The chart gives a false impression that the child is catching up. What is this presentation?

Pediatric Obesity

Educate! Behavioral changes- emotions Eat real food! Lifestyle modifications- activity Portion sizes huge on veggies! Reduced carbs and bad fats Food choices (find healthy choices the kid likes, try new foods often) Food substitutions NO caloric beverages, soda etc. NO "diet" foods NO eating after 6pm NO high fructose corn syrup! Water first when hungry, 20 minutes later a health snack Keep only healthy food in the house Treat Parents and Child Both What management is this for?

Electrical Safety

Electrical injuries result in 3,000 admissions and 1,000 fatalities annually Place covers on electrical outlets. Talk to parents when discussing "baby proofing" the house Tell school age kids: Never touch electrical outlets or play with electrical cords If you are in water, do not touch anything electrical Never play near areas marked DANGER: HIGH VOLTAGE. Come indoors during a lightning storm Do not climb trees near power lines. Do not throw anything at utility wires. Do not fly kites near wires What anticipatory guidance is this?

Thyroid Function

Embryogenesis begins on the floor of the primitive oral cavity, and the gland descends to its definitive position in the anterior low neck by the end of the first trimester May have functional ectopic thyroid gland, but most often it becomes insufficient by early to mid childhood to support full thyroid secretion The hypothalamic-pituitary-thyroid axis becomes functional in the second trimester Peripheral metabolism of thyroid hormones matures in the third trimester These are 3 stages of what?

Hypoparathyroidism

Emergency treatment of tetany: IV calcium gluconate 1-2 ml/kg of 10% solution given over 10 minutes while cardiac function is assessed Diet: High calcium diet with supplements Vitamin D supplementation: Ergocalciferol (vitaminD2) Calcitriol (1, 25-dihydroxy vitamin D3) Monitoring: Monitor serum calcium, urine calcium, and serum alkaline phosphatase levels at 1- to 3-month intervals What management is this for?

Asthma

Endogenous Factors: Genetic predisposition Atopy Airway hyperresponsiveness Gender Ethnicity Obesity Early viral infections Env factors: Indoor allergens Outdoor allergens Occupational sensitizers Passive smoking Respiratory infections Diet Acetaminophen These risk factors are associated with what?

EBV

Etiologies: Epstein barr virus, cytomegalovirus Symptoms: Fever, Sore throat, upset stomach Exam: tonsillar hypertrophy, non-exudative or non-exudative, palatal ptechiae, LUQ tenderness/splenomagaly, very large cervical adenopathy-posterior more common Treatment: supportive, limited physical activity, temperature and fluid regulation. What is this?

Asthma

Etiology: Atopy: develop symptoms before their fifth birthday Atopy (personal or familial) is the strongest identifiable predisposing factor Sensitization to inhalant allergens increases over time and is found in the majority of children with THIS Perennial aeroallergens such as dust mite Animal dander Cockroach Alternaria (a soil mold) Foods may provoke isolated asthma symptom Infections: About 40% of infants and young children who have wheezing with viral infections in the first few years of life will have continuing THIS through childhood Respiratory syncytial virus [RSV] Rhinovirus Parainfluenza and influenza viruses Metapneumovirus RSV may be the predominant pathogen of wheezing infants in the emergency room setting, but rhinovirus can be detected in the majority of older wheezing children Acetaminophen: Observational studies have also demonstrated an increased risk of THIS attributed to acetaminophen exposure during prenatal periods, infancy, childhood, and even adulthood Acetaminophen is the most commonly used antipyretic medication for children in the United States There are several mechanisms which have been proposed Etiology: Other triggers include: Exercise Cold air Cigarette smoke and exposure, especially from mother Pollutants Strong chemical odors Rapid changes in barometric pressure Aspirin sensitivity is uncommon in children What is this?

Cervical Spine Injuries

Evaluation Prompt recognition of any potentially catastrophic injuries is essential Proper management prevents excessive movement so as not to exacerbate any initial damage to the spine and reduce the chance of a secondary injury Assessment on Field Primary survey Secondary surveys Question about extremity numbness, painful dysesthesias or paresthesias, weakness, and neck pain Immobilize athletes with obvious deficit in movement, significant sensory disturbance, or neck pain Cervical spine radiographs should be immediately obtained What is this with PPE?

Congenital Hypothyroidism

Even when the thyroid gland is completely absent, most newborns with THIS appear normal at birth and gain weight normally for the first few months of life without treatment Detected commonly on newborn screening test It may be transient but permanent occurs in the majority Findings at various stages after birth include: Thick tongue Gestation greater than 42 weeks Birth weight greater than 4 kg Hypothermia Acrocyanosis Respiratory distress Abdominal distention and constipation Lethargy and poor feeding Large fontanelles Hypotonia Jaundice more than 3 days after birth Edema Mottled, dry skin Large posterior fontanel Umbilical hernia Hoarse cry What clinical presentation is this for?

T4 or TSH

Every state in the U.S. requires newborn testing Depending on the state, the newborn screen measures either the total WHAT or WHAT level Abnormal newborn screening results should be confirmed immediately with a WHAT and WHAT level Total T4 and FT4 levels are decreased, while T3 resin uptake (T3RU) is low Thyroid imaging does not affect the treatment plan and is not necessary When secondary hypothyroidism is detected, investigation of pituitary-hypothalamic anatomy via MRI is indicated

Fire Safety

Every year, 400 children under age 10 die in home fires Talk to parents about: Smoke alarms Keeping matches and lighters away from children Having a fire escape plan, and practicing it Learn two ways out of every room Agree on a meeting place. If you are in a room with a closed door when fire occurs: Do not open the door if you see smoke under it. Check the door handle Stay low to the ground Yell for help or call 911 if you have a phone Do not hide! Discuss this with parents of young and school age children. What anticipatory guidance is this?

Palmar grasp

Evident with the placement of the examiner's finger in the newborn's palm; develops by 28 weeks' gestation and disappears by age 4 months. What neuro exam is this?

Newborn PE

Examination of the genitalia is next. In males inspection of the penis should reveal a foreskin that completely covers the glans. Gently slightly retract the foreskin to observe the urethral meatus. Testes can be palpated in the scrotum. Placing females in a frog-leg position allows for a careful exam of the labia majora and minora. The clitoris should be visible and also the urethral and vaginal openings. The anus should be inspected for placement and patency. Examine the extremities for range of motion and any anomalies, such as extra digits or webbing. Check for leg length differences. The hips should be examined for dislocation. Tests for this include Ortolani and Barlow maneuver shown here. What is this?

HEENT

Face: Document facial bruising and forceps location Facial nerve palsy is most obvious during crying; the unaffected side of the mouth moves normally, giving an asymmetric grimace Ears: Malformed or malpositioned (low-set or posteriorly rotated) ears are often associated with other congenital anomalies The tympanic membranes should be visualized Any external ear abnormality may be associated with hearing loss Eyes: Subconjunctival hemorrhages are a frequent result of birth trauma A corneal tear (presenting as a clouded cornea), or a hyphema (a layering of blood in the anterior chamber of the eye) may occur Ophthalmologic consultation is indicated in such cases Extraocular movements should be assessed Occasional uncoordinated eye movements are common, but persistent irregular movements are abnormal The iris should be inspected for abnormalities Retinal red reflexes should be present and symmetrical Dark spots, unilateral blunted red reflex, absent reflex, or a white reflex all require ophthalmologic evaluation Nose: Examine the nose for size and shape Any nasal obstruction (eg, bilateral choanal atresia or stenosis) can cause respiratory distress Purulent nasal discharge at birth suggests congenital syphilis ("snuffles") Mouth Epithelial (Epstein) pearls are benign retention cysts along the gum margins and at the junction of the hard and soft palates Check the integrity and shape of the palate for clefts and other abnormalities Excessive oral secretions suggest esophageal atresia or a swallowing disorder What newborn PE is this?

5th% 2 major

Failure to thrive: Definition- Weight < WHAT Weight for height <WHAT Weight crossing (declining) WHAT percentiles in 3-6 months.

Hypertrophic Cardiomyopathy

Familial hypertrophic cardiomyopathy Autosomal dominant Can be sporadic Clinical Presentation Asymptomatic (onset of symptoms coincides with rapid growth and development) Inadequate coronary perfusion Angina Dyspnea Infants (poor growth, cry while feeding, excessive sweating) Syncope Palpitations Exercise intolerance CHF Sudden cardiac death Cardiac examination Normal Left precordial bulge Diffuse PMI S4 SEM exacerbated by maneuvers that decrease left ventricular volume Valsalva Standing What is this?

2-8

Fear of darkness and animals is considered normal during what years and after that is phobia or anxiety disorder?

Hyperthyroidism

Females more commonly affected, and symptoms develop in adolescence Typically cyclic, with spontaneous remissions and exacerbations Symptoms include: Worsening school performance Personality Disturbance Poor concentration Insomnia Fatigue Weight loss Hyperactivity Palpitations Emotional lability Heat intolerance Nervousness Increased perspiration Personality disturbance Menstrual irregularities What clinical presentation is this?

Total Replacement Fluid Therapy

Fluids during the first 24 hours: Emergency Phase: Initial Bolus of 20 ml/kg 50% remaining deficit + maintenance for first 8 hours 50% remaining deficit + maintenance for next 16 hours What is this for?

Sexual Abuse

For nonsexually active, prepubertal girls, an internal speculum examination is rarely necessary unless there is suspicion of internal injury The external female genital structures can be well visualized using labial separation and traction with the child in the supine frog leg or knee-chest position If there is a history of possible THIS of any child within the past several days, and the child reports a physical complaint or a physical sign is observed (e.g., genital or anal bleeding or discharge), the child should be examined for evidence of trauma Colposcopic examination may be critical for determining the extent of the trauma and providing documentation for the legal system Prior to any speculum exam of an assault victim, it is important to consider the child's physiologic and emotional maturation, and whether she has been sexually active or had a speculum exam in the past

D5 NS

For routine maintenance in infants, use what IV fluid?

Normal Saline

For routine maintenance in non infants, use what IV fluid?

Volume Loss

For the majority of children, the physical examination remains crucial and should begin by assessing the child's overall appearance, level of activity, responsiveness, respiratory pattern, and vital signs No single variable in isolation is sufficiently accurate to determine the severity of dehydration The percent of body weight lost remains the gold standard measurement of dehydration What is this assessing with acute gastroenteritis?

3

Frequent falling Unclear speech No short phrases No pretend play Little interest in other children Extreme separation anxiety These developmental warning signs occur during what years?

Constipation

Functional or Retentive causes Dietary: Under-nutrition, lack of bulk Cathartic abuse Drugs Opiates, *antihistamines*, Some antidepressants Structural defects of GI tract Anus and rectum: Fissure, hemorrhoids, abscess Anal and rectal stenosis Small bowel and colon: Tumor, stricture Volvulus, intussusception Smooth muscle disease Scleroderma and dermatomyositis Systemic Lupus Erythematosus Abnormalities of myenteric ganglion cells Hirschsprung disease-lack autonomic response Waardenburg syndrome Hypo- and hyperganglionosis Von Recklinghausen disease Multiple endocrine neoplasia 2b Chronic intestinal pseudo-obstruction Spinal cord defects Metabolic and endocrine disorders Hypothyroidism Hyperparathyroidism Diabetes insipidus Vitamin D intoxication Skeletal muscle weakness or incoordination Cerebral palsy Muscular dystrophy/myotonia What causes are these of?

B3

Further enlargement of breast and areola with no separation of their contours What Tanner stage is this?

HPV

GARDASIL 9 is indicated in males and females 9 through 26 years of age for the prevention of cervical, vulvar, vaginal, anal cancers, precancerous or dysplastic lesions caused by human papillomavirus (HPV) Types 16, 18, 31, 33, 45, 52, and 58; and genital warts and precancerous or dysplastic lesions caused by HPV Types 6 and 11 Only 2 doses needed if series started before age 15. 3 doses needed if started at or after age 15. Gardasil 9 replaces the quadrivalent version that covered 6,11,16,18. 11 or 12 year old males AND females vaccinated routinely Catch up for females age 13-26 and males age 13-21 Contraindicated-pregnancy Adverse Effects-injection site pain, mild to moderate swelling and erythema, fever, nausea, dizziness, possible syncope after injection What vaccine is this for children?

Iron

GI decontamination Shock is treated in the usual manner Deferoxamine, a specific chelating agent for THIS, is a useful adjunct in the treatment of severe THIS poisoning Hemodialysis, peritoneal dialysis, or exchange transfusion can be used to increase the excretion of the dialyzable complex Serum THIS levels fall rapidly even if deferoxamine is not given After the acute episode, liver function studies and an upper GI series are indicated to rule out residual damage. What overdose tx is this for?

Juvenile Rheumatoid Arthritis (JRA)

General Also called juvenile idiopathic arthritis or juvenile chronic arthritis May involve one or multiple joints and cause fevers, rash, or eye inflammation Four criteria for diagnosis: Chronic synovial inflammation of unknown cause Onset in children under 16 years of age Objective evidence of arthritis in one or more joints for 6 consecutive weeks. Exclusion of other diseases What is this?

Sever's Disease

General Calcaneal apophysitis Active, pre-pubertal children Characterized by pain in the posterior aspect of the heel that occurs during and after activity Repetitive stress and micro-traumas occur at the calcaneal apophysis Most common around age 9-11 What is this?

Clavicle

General Common site of fracture in children Usually in middle or distal 1/3 of the clavicle shaft Mechanism is typically fall or direct blow to shoulder Clinical Presentation Refusal to move arm, especially in newborns Acute pain, tenderness, swelling, palpable deformity Physical Examination Deformity on inspection and palpation Assess skin for tenting or blanching Assess motor and sensory functions Imaging AP radiographs of clavicle What fracture is this?

Tibial

General Diaphyseal and proximal metaphyseal fractures are more common in younger children, while growth plate and intra-articular fractures are more common in older children. Tibia is a common site of fracture in child abuse victims Clinical Presentation Acute pain, inability to walk. Toddler's fractures, minimally displaced fractures and stress fractures may present with vague symptoms or insidious onset with muscle swelling tenderness and limp Physical Examination Assess neurovascular status. Evaluate for compartment syndrome especially with proximal physeal and midshaft fractures. Look for puncture wounds or abrasions which may signify open fracture Imaging AP and lateral radiographs of tibia to include both the knee and ankle CT may be necessary to visualize complex fracture of the distal tibia, such as triplane fractures or Tilleaux fractures What fracture is this?

Slipped Capital Femoral Epiphysis (SCFE)

General Displacement of the femoral head through the physis Typically occurs during the adolescent growth spurt In adolescence the proximal femoral physis orientation changes from horizontal to oblique position Increased body weight in this age group increases shear force through weak physis Microscopic fracture and gradual slip of femoral head posteriorly and medially What is this?

Femur

General Femur fractures in children are usually the result of significant trauma, but can occur from simple falls Clinical Presentation Acute pain, tenderness, swelling, inability to bear weight, deformity, history of trauma. Most occur in the femoral shaft Physical Examination Pain and inability to walk will be immediate Palpable pain will localize to femur Evaluate circulation and tibial and peroneal nerve function What fracture is this?

Forearm

General In children forearm fractures of the proximal and mid-portion typically affect both bones Clinical Presentation Acute pain, tenderness, swelling, palpable deformity Fall on outstretched arm (FOOSH injury pattern) Physical Examination Assess median, ulnar, and radial nerve function Assess for compartment syndrome and educate parents on the symptoms. Severe pain with passive extension of fingers should be worrisome Imaging AP and lateral radiographs of the forearm Assess fracture alignment, radial head position Types: Torus - Greenstick radius or ulna, possible both Complete Fracture - Complete disruption of one or both bones What fracture is this?

Radial Head Subluxation (Nursemaids Elbow)

General Most common elbow injury in children under 5 years Mechanism is pull on forearm with elbow extended and forearm pronated Annular ligament slips around radial head and becomes interposed between radius and ulna Clinical Presentation Child will immediately cry but initial pain subsides quickly Reluctance to use arm Arm is usually at side with elbow slightly flexed and forearm pronated Physical Examination Radial head tenderness Resistance to supination Treatment Reduction - Place thumb over radial head and supinate forearm while flexing the elbow Immobilization is usually not necessary What is this?

Supracondylar Humerus

General Most common fracture around the elbow in children Typically affects ages 2-12 Clinical Presentation Acute pain, tenderness, swelling with history of fall on outstretched arm Refusal to move arm Physical Examination Evaluate median, ulnar, and radial nerves Assess distal pulses Palpate area of maximal tenderness Imaging AP and lateral radiographs of the elbow What fracture is this?

Osgood-Schlatter Disease

General Osteochondritis of the tibial tuberosity Results from small avulsion fracture of the bone-tendon junction patellar tendon on tibial tuberosity ossification center Onset is in early adolescence Five times more common in patients who are active in sports More common in boys What is this?

Calcaneovalgus Foot (Flatfoot)

General abnormally low or absent longitudinal arch. Flexible is more common and is normal in infants and in up to 20% of adults Flexible in children is always bilateral. When non-weight bearing there is a visible arch with normal mobility of the hind foot (inversion/eversion) Rigid may be unilateral. Usually associated with tarsal coalition Neuromuscular conditions which cause hypotonia and ligamentous laxity can result in flexible which may progress to rigid deformity. (Marfan syndrome, Ehlers-Danlos syndrome, Down syndrome) What is this?

Thyroid Storm

General Symptoms: Fever (105F) Thyroid Nodule Diffuse enlargement Ophthalmologic Ophthalmopathy Uncommon in Pediatric cases Neurologic Anxiety, psychosis, seizure Hyperreflexia Coma Cardiovascular Sinus tachycardia Hyperdynamic precordium Atrial fibrillation Gastrointestinal N/V/D Abdominal pain Jaundice Hepatosplenomegaly Skin Moist Pretibial myxedema What is this?

Marfan Syndrome

Genetic disorder characterized by skeletal and cardiovascular changes Skeletal changes Tall stature Arachnodactyly (long thin fingers) Dolichosenomelia (long, thin limbs) Hypermobility of joints Arm span:height > 1.05 Scoliosis Chest wall deformity (pectus excavatum or carinatum) Cardiovascular changes Progressive dilation of aortic root or descending aorta Predisposition to rupture and sudden death if the aortic transverse dimension >50 mm MVP- with associated mitral regurgitation or LV dysfunction can participate in low and moderate static/low dynamic competitive sports unless they have one or more of the following: Aortic root dilatation Moderate-to-severe mitral regurgitation Family history of dissection or sudden death in a relative with the dz It is recommended, however, that these athletes have an echocardiographic measurement of aortic root dimension repeated every six months What is this found on PPE?

G5

Genitalia adult in size and shape. No further enlargement takes place after THIS stage is reached. What Tanner stage is this in boys?

Fluid Bolus

Give replacement fluids early and aggressively in a WHAT To give a fluid bolus, calculate 20ml/kg weight Subtract the bolus amount from the total replacement fluids needed Use Normal Saline What is this?

Hypoglycemia

Glucose Growth Hormone Cortisol FFA Beta hydroxybutyrate and acetoacetate Serum Lactate Urinalysis Ketones and reducing substances What DDx is this for?

Diabetes Type 1

Glycosuria occurs when the serum glucose concentration exceeds the renal threshold for glucose reabsorption (>180 mg/dL) This glycosuria causes an osmotic diuresis, leading to loss of sodium, potassium, and electrolytes Polydipsia occurs as the patient attempts to compensate for the excess fluid losses Protein stores in muscle and fat stores in adipose tissue are metabolized to provide substrates for gluconeogenesis and fatty acid oxidation Weight loss results from the persistent catabolic state and the loss of calories through glycosuria and ketonuria These changes lead to the common clinical manifestation of diabetes: Polyuria Polydipsia Polyphagia Weight loss If the clinical features of new-onset are not detected, diabetic ketoacidosis (DKA) will occur What pathophys and clinical manifestation is this for?

Pre-Participation Exam (PPE)

Goals: Identify conditions that would predispose children to serious injury or death Identify conditions that could be worsened by exercise Diagnose previously undetected conditions Assess general health and risk taking behaviors Meet school, state, and insurance requirements Assess fitness level Primary Care Station Method Groups of athletes move through multiple stations. May involve medical assistants, nurses, coaches, athletic trainers, physical therapists, and physicians and PAs Timing Ideally perform at least 6 weeks prior to start of athletic season Most states require examination annually History Questionnaire completed by parent/guardian AND the patient History question should emphasize cardiovascular symptoms: dizziness or syncope with exercise, chest pain, shortness of breath, palpitations, and fatigability Family history is important as many cardiovascular conditions are hereditary. Should include history of sudden death of relative prior to age 50, Marfan syndrome, long QT syndrome, etc. What is this?

G3

Growth of the penis has occurred, at first mainly in length but with some increase in breadth; further growth of testes and scrotum What Tanner stage is this in boys?

ALTE

HPI - detailed description of event: breathing, heart beat, how long, stimulation, awake, sleep, feeding, color change, bizarre movement History - premature, seizures, BPD, GER PE - general appearance, VS, pulse ox, HEENT (fontanel), neck (rigidity), chest (labored breathing, stridor, murmurs), neuro Lab/studies - CBC, BC, electrolytes with AG, CSF, UA, UC, ECG, EEG, CXR, pH, UGI, CT/MRI What is this?

P5

Hair is adult in quantity and type, distributed as an inverse triangle of the classic feminine pattern. Spread is to the medial surface of the thighs but not up the linea alba or elsewhere above the base of the inverse triangle. What Tanner stage is this in girls?

P5

Hair is adult in quantity and type, distributed as an inverse triangle. Spread is to the medial surface of the thighs but not up the linea alba or elsewhere above the base of the inverse triangle. Most men have further spread of pubic hair. What Tanner stage is this in boys?

P3

Hair is considerably darker, coarser, and curlier and spreads sparsely What Tanner stage is this in boys?

P3

Hair is considerably darker, coarser, and curlier. The hair spreads sparsely over the superior junction of the labia majora What Tanner stage is this in girls?

P4

Hair is now adult in type, but the area covered by it is still considerably smaller than in most adults. There is no spread to the medial surface of the thighs What Tanner stage is this in girls?

P4

Hair is now adult in type, but the area it covers is still considerably smaller than in most adults. There is no spread to the medial surface of the thighs What Tanner stage is this in boys?

AS HCM MVP

Handgrip (increases aferload SVR) What murmurs will decrease?

AR MR VSD (ventricular septal defect)

Handgrip (increases afterload SVR) What murmurs will increase?

Nutrition tips in kids

Have regular family meals cooked at home Involve kids in grocery shopping, packing lunch, and cooking Teach the nutritional value of foods and how to read food labels "Life foods vs. death foods" Increase portions of healthy foods Encourage WATER Eat more fruits and veggies Top cereal with fruit Create a food collage or animal Make frozen fruit kabobs Drink fruit smoothies with spinach or kale Add veggies and fruits to baked goods Have fresh fruit and veggies as snacks Puree veggies and sneak them in What is this for?

Child Abuse

Head and abdominal trauma may present with signs and symptoms consistent with those injuries Symptoms can be subtle and may mimic other conditions such as gastroenteritis The finding of retinal hemorrhages in an infant without an appropriate medical condition (e.g., leukemia, congenital infection, or clotting disorder) should raise concern about possible inflicted head trauma Retinal hemorrhages are not commonly seen after cardiopulmonary resuscitation in either infants or children What presentation is this for?

Shaken Baby Syndrome

Head injury leading cause of mortality from physical abuse Most commonly related to men Often in response to crying child Present with variety of findings: Seizures Lethargy and irritability Apnea Coma Misdiagnosed ~25% of cases Mild injuries Younger than 6 months old White infants living in 2 parent households What is this?

Rooting reflex

Head turns to the side of a facial stimulus, present by 28 weeks' gestation. What neuro exam is this?

Hyponatremia

Headache Nausea and vomiting Confusion and disorientation Irritability Lethargy Reduced consciousness Convulsions Coma Apnea What are these signs of?

Discipline

Help parents establish behavioral control in the right way Give examples of different techniques Refer to counselors when necessary Children NEED order It's okay to say NO Use: Logical Consequences Time Out Rules Never discipline your child when angry (Walk away) Be consistent Abuse: Physical abuse is: Unpredictable. There are no clear rules. Done in anger... not to lovingly teach the child. Using fear to control behavior. Abuse can be... Emotional Physical Sexual Neglect What is this related to?

12 months-2 years

Hep A series start between What months and year in kids?

Septic Arthritis

History Previously ambulating child who suddenly refuses to ambulate Usually no history of injury Patient is usually in exquisite pain Signs and Symptoms Fever, toxic appearing child, redness, tenderness, warmth, soft tissue swelling May affect any joint, but most commonly hip or knee What is this?

Failure to thrive

History (Key to Dx)- Prenatal hx. (caloric intake, diet, smoking, alcohol, substance abuse, medications, illnesses) Feeding methods Observe parent/child interaction Labs to r/o organic causes: CBC, UA, UC, HIV, TSH, PPD, lytes, Cr, stool O&P/culture, and amino acids. <2% of labs will result in discovery of THIS etiology when history is unclear!!!

Moro (startle) reflex

Hold the infant supine while supporting the head. Allow the head to drop 1-2 cm suddenly. The arms will abduct at the shoulder and extend at the elbow with spreading of the fingers. Adduction with flexion will follow. This reflex develops by 28 weeks' gestation (incomplete) and disappears by age 4 months. What neuro exam is this?

FSH LH

Hormonal changes in puberty: females: WHAT stimulates ovarian maturation, granulosa cell function, and estradiol secretion WHAT is important in ovulation and also is involved in corpus luteum formation and progesterone secretion Estradiol becomes stimulatory, and the secretion of LH and FSH becomes cyclic Estradiol levels progressively increase, resulting in maturation of the female genital tract and breast development

LH FSH

Hormonal changes in puberty: males: WHAT stimulates the interstitial cells of the testes to produce testosterone WHAT stimulates the production of spermatocytes in the presence of testosterone The testes also produce inhibin, a Sertoli cell protein that inhibits the secretion of FSH Levels of testosterone correlate with the physical stages of puberty and the degree of skeletal maturation.

25-35

How many pounds should a pt gain with pregnancy when the BMI is 18.5-24.9?

15-25

How many pounds should a pt gain with pregnancy when the BMI is 25-29.9?

30-40

How many pounds should a pt gain with pregnancy when the BMI is less than 18.5?

11-20

How many pounds should a pt gain with pregnancy when the BMI is over 30?

Pyloric Stenosis

Hypochloremic, hypokalemic metabolic alkalosis with elevated BUN:Cr is the classic findings Dehydration causes elevated hemoglobin and hematocrit Mild unconjugated bilirubinemia occurs in 2%-5% of cases Ultrasound shows marked elongation and thickening of the pylorus A barium upper GI series reveals retention of contrast in the stomach and a long narrow pyloric channel with a double track of barium Isolated pylorospasm is common in young infants and by itself is insufficient to make a diagnosis of THIS

Salter Harris

I - Through growth plate II - Through growth plate and metaphysis, spares epiphysis III - Through growth plate and epiphysis, spares metaphysis IV - Through metaphysis, growth plate, and epiphysis V - Crushed growth plate I - Straight across II - Above III - Lower IV - Through everything V - Rammed What is this classification in children?

Poliovirus

IPV is inactivated IPV is given in 4 doses at 2 months, 4 months, 6-18 months, and 4-6 years The dose at age 4 or older should be given regardless of number of prior doses of IPV Contraindications-moderate-severe acute illness Precaution-pregnancy Adverse Effects-minor local reactions, no serious reactions after IPV ever described What vaccine is this in children?

Hyponatremia

If a child is prescribed a hypotonic fluid1/2 NS(.45% NaCl), change to an isotonic fluid/NS (0.9% NaCl). Restrict maintenance IV fluids if pt. is hypervolemic (ex., if increased ADH secretion): Restrict maintenance fluids to 50-80% of routine needs What is this managing that develops during IV fluid therapy?

Type 2 Diabetes

If the HbA1c is still near normal, modification of lifestyle (preferably for the entire family) is the first line of therapy This must include reducing caloric intake and increasing exercise With mildly elevated HbA1c (6.2%-8.0%) and no ketosis, metformin is usually started at a dose of 500 mg twice daily along with modification of lifestyle If needed the dose can be gradually increased to 1 g twice daily If the presentation is more severe, with ketosis, the initial treatment is similar to that of T1D, including IV or subcutaneous insulin Oral hypoglycemic agents may be tried at a later date, particularly if weight loss has been successful 10% of children with THIS present in DKA Diet: Nutritional management in children with diabetes does not require a restrictive diet, just a healthy dietary regimen from which the children and their families can benefit Exercise: Helps increase insulin sensitivity (a drop in glycemia in response to insulin); and helps maintain proper weight, blood pressure, and HDL-cholesterol levels. Hypoglycemia can occur during exercise or in the 2-12 hours after exercise The use of drinks containing 5%-10% dextrose, such as Gatorade, during the period of exercise is often beneficial What management is this for?

Encopresis

If the child has a loaded colon and rectum, it is likely that his or her rectum is insensitive to distension The colon should be washed out, and laxatives and stool softeners used until fecal masses can no longer be palpated and the child is passing regular stools of normal consistency Parents should be educated to administer a behavioral program Coercion, punishment, and criticism should be avoided The child should be asked to sit briefly on the toilet at the same time twice per day: after breakfast and after school All tension should be removed from the toileting experience The parent should make no comment if no bowel movement is passed; in contrast, the parent should praise and offer individualized reward to the child if toileting is successful Star charts are useful both as a record and for reinforcement Both parents should be involved in treatment May require years of treatment prior to successful outcomes What is this tx for?

Rubella

If woman develops THIS in the first trimester of pregnancy, there is an increased risk of both spontaneous abortion and congenital rubella syndrome Intrauterine growth retardation Microcephaly Microphthalmia, Cataracts, retinopathy, and glaucoma Hepatosplenomegaly Jaundice PDA Blueberry muffin rash Congenital heart disease MR Deafness (sensorineural) Risk of congenital rubella is related to the gestational age at the time of infection, found highest in first 12 weeks of pregnancy Screening available (IgM) What maternal infection is this?

PUD

Illnesses predisposing to secondary ulcers include: Central nervous system (CNS) disease Burns Sepsis Multiorgan system failure Chronic lung disease Crohn disease Cirrhosis Rheumatoid arthritis The most common drugs causing secondary ulcers are aspirin, alcohol, and NSAIDs Severe ulcerative lesions in full-term neonates have been found to be associated with maternal antacid use in the last month of pregnancy In children younger than 6 years, vomiting and upper GI bleeding are the most common symptoms of gastric and duodenal ulcer Older children are more likely to complain of epigastric abdominal pain The first attack of acute H pylori gastritis may be accompanied by vomiting and hematemesis Chronic blood loss may cause iron-deficiency anemia Deep penetration of the ulcer may erode into a mucosal arteriole and cause acute hemorrhage What is this?

Femur

Imaging AP and lateral radiographs of the femur including hip and knee joints Stress views may be necessary to identify distal femur physeal fractures Treatments Flexible nail fixation Open reduction internal fixation Spica cast What fracture is this for?

Supracondylar Humerus

Imaging Fracture may be subtle. Comparison view so unaffected side may be necessary Radial head should be directed toward the capitellum Look for anterior and posterior fat pad sign Presence of posterior fat pad sign is associated with fracture What fracture is this for?

Status Asthmaticus

Imminent signs of respiratory arrest: Altered mental status Paradoxical respirations Bradycardia Quiet chest Absence of pulsus paradoxus from respiratory muscle fatigue What is this?

SLE

Immune abnormalities in WHAT can lead to production of anti-Ro (SS-A) and anti-La (SS-B) antibodies that can cross the placental and injure fetal tissue Most significant complication is damage to cardiac conducting system, resulting in congenital heart block (3rd degree) Mortality rate is 20% Neonatal lupus may occur, and symptoms include skin rash, thrombocytopenia, autoimmune hemolysis, hepatic disease Anti-Ro and anti-La antibodies can cross the placenta and injury fetal tissue Increased risk of: Spontaneous miscarriage Fetal Death Pre-eclampsia Preterm labor/delivery IUGR Congenital heart block Relates to: Age, parity Anti-cardiolipin antibodies Associated nephritis Hypertension Active disease seen at time of conception First presentation of SLE during pregnancy

Pediatric Fever

Important historical data includes: Duration of fever How the temperature was measured Maximum height of fever documented at home All associated symptoms Any chronic medical conditions Any medications taken Medication allergies Fluid intake Urine output Exposures and travel Any additional features of the illness that concern the parents What hx is this for?

7.5-8.5%

In children, we want the hemoglobin A1C to be btw what?

Lanugo

In extreme immaturity, the skin lacks any lanugo. It begins to appear at approximately the 24th to 25th week and is usually abundant, especially across the shoulders and upper back, by the 28th week of gestation. Thinning occurs first over the lower back, wearing away as the fetal body curves forward into its mature, flexed position. Bald areas appear and become larger over the lumbo-sacral area. At term, most of the fetal back is devoid of THIS What is this w/ballard scoring

Pneumonia

In infants already receiving respiratory support, an increase in the requirement for oxygen or ventilator support, perhaps with a change in the character of tracheal secretions, may indicate THIS Common bacteria and viruses considered CMV, respiratory syncytial virus, adenovirus, influenza, herpes simplex, parainfluenza and Chlamydia can cause THIS

Galactosemia

In infants receiving foods containing galactose, laboratory findings include: Liver dysfunction PT prolongation Proteinuria Aminoaciduria Absence of reducing substances in urine does not exclude the diagnosis Galactose-1-phosphate is elevated in red blood cells Galactose-1-phosphate uridyltransferase should be assayed in erythrocytes Newborn screening by demonstrating enzyme deficiency in red cells with the Beutler test or by demonstrating increased serum galactose allows timely institution of treatment What Dx is this for?

Nursery care

In many centers, glucose testing is done on all infants regardless of weight. Vitamin K and eye prophylaxis is given to all infants. Silver Nitrate causes chemosis and is not effective against Chlamydia Trachomatis infection of the eyes. Erythromycin prevents Gonococcal and Chlamydial disease. Vitamin K is given intramuscularly (IM) to protect against hemorrhagic disease of the newborn. Hep B vaccine before discharge. Hep B immunoglobulin and vaccine within 12 hours if mother is Hep B surface antigen positive. The state required newborn screening is done at discharge, and again at two weeks. What is this?

Acute Gastroenteritis

In the United States, rotavirus primarily affects infants between 3 and 15 months of age. The peak incidence in the United States is in the winter with sporadic cases occurring at other times. The virus is transmitted via the fecal-oral route and survives for hours on hands and for days on environmental surfaces Vomiting is the first symptom in 80%-90% of patients, followed within 24 hours by low-grade fever and watery diarrhea. Diarrhea usually lasts 4-8 days What clinical presentation is this for?

Normal Bowel Function

In the first week of life, infants have an average of four stools per day, which gradually decreases over time and depends on the type of feeds A breastfed baby will have a mean of 2.9 stools/d compared to two in a formula-fed baby Infants may go 1 or 2 days without a bowel movement, and as long as the child is not straining and the stool is not hard, it is still considered within normal limits By 3 years of age, children usually stool once a day What is this?

Hypothyroidism

In this resulting from enzymatic defects, ingestion of goitrogens (for mother's hyperthyroid), or chronic lymphocytic thyroiditis, the thyroid gland may be enlarged Rare Thyroid enlargement in children is usually symmetrical, and the gland is moderately firm and not nodular In chronic lymphocytic thyroiditis, however, the thyroid frequently has a cobblestone surface

Chronic HTN/Preeclampsia on Fetus

Increased risk of fetal mortality 21 deaths/1000 live births Intrauterine growth restriction (IUGR) Hematologic effects Thrombocytopenia Neutropenia Bronchopulmonary Dysplasia Hypoxia may lead to angiogenesis that can affect lung development May be related to growth restriction What are these effects of?

Vancomycin & ampicillin & ceftriaxone OR cefotaxime

Infant - (29 to 90 days) Common: S. pneumoniae, H. influenzae, N. meningiditis Less common: Group B Streptococcus, E. coli, S. aureus, Enterococcus, Listeria monocytogenes, Pseudomonas sp., other Gram negative organisms CSF pleocytosis or ill-appearing What antibiotic coverage should be used?

Ceftriaxone OR cefotaxime

Infant - (29 to 90 days) Common: S. pneumoniae, H. influenzae, N. meningiditis Less common: Group B Streptococcus, E. coli, S. aureus, Enterococcus, Listeria monocytogenes, Pseudomonas sp., other Gram negative organisms Well-appearing, no CSF pleocytosis what antibiotic coverage should be used?

Constipation

Infant and pediatric THIS is usually diet related Decreased H2O intake Too little fiber (rice, bread, pasta) Too much milk, yogurt, baby cereal NOT everything a parent thinks is THIS is THIS What is this?

UTI

Infants Failure to thrive Jaundice Vomiting and diarrhea +/- fever Irritability Toddlers/preschool Frequency/dysuria Enuresis Maladorous urine Fever Abdominal pain Often associated with GU anomalies posterior urethral valves (males), ureterocele, abnormal implantation of ureters Lead to VUR (vesicoureteral reflux) What is this?

Nursery

Infants all have a period of transitioning from intrauterine life. The normal newborn nursery is set up for the 85-90% of term newborns who do well, but is also geared to care for infants who have problems with transition. Currently, ALL normal newborns are treated as "recovery" patients, until they have demonstrated the ability to transition smoothly. It is important to keep in mind that newborns, especially Pre-Term Infants, respond paradoxically to hypoxia with Apnea rather than Tachypnea as occurs in adults. a more detailed physical examination should be done, and a careful estimate of gestational age. Always make sure to RECORD ALL findings! Orders should be written, based on the needs of a specific child. THESE orders should reflect the child's weight and gestational age. If risk factors for illness are found, intervention should begin at this time. When the infant is stable and clean, a more careful assessment of gestational age should be done. Based on the gestational age, some problems may be anticipated and resolved before becoming more complicated. Accurate dating from the first date of a last menstrual period is sometimes impossible, so a physical assessment if gestational age is necessary. Three terms for describing these infants are small for gestational age, large for gestational age, and appropriate for gestational age. This can be written as SGA, LGA, or AGA. What is this?

Normal

Infants lose weight after delivery, this is WHAT?! Original birth weight should be regained by 2 weeks post delivery

Esophageal astresia

Infants present in the first hours of life with copious secretions bubbling from nose and mouth, choking, cyanosis, and respiratory distress Diagnosis is confirmed with chest radiograph after careful placement of a 10 French or larger nasogastric (NG) tube to the point at which resistance is met If a tracheoesophageal fistula is present to the distal esophagus, gas will be present in the bowel In THIS without tracheoesophageal fistula, there is no gas in the bowel

Dyschezia

Infants younger than 3 months normally grunt, strain, and turn red in the face while passing normal stools The diagnostic criteria for infant WHAT are at least 10 minutes of straining and crying before successful passage of soft stools in an otherwise healthy infant younger than 6 months Infants and children may, however, develop the ability to ignore the sensation of rectal fullness and retain stool-schedule toileting Factors reinforcing this behavior include: Painful defecation Skeletal muscle weakness Psychological issues, especially those relating to abuse, control and authority Modesty and distaste for school bathrooms Medications (Narcotics, antihistamines, antidepressants, vincristine)

Otitis Externa

Infection of the External auditory canal. Often termed swimmer's ear Other types include: Localized OE Chronic (greater than 6 weeks) Eczematoid Necrotizing Otomycosis Presentation: Pain Drainage Pressure/fullness Swelling/erythema Decreased hearing HPI Swimming Moisture exposure Injury Diagnosis Clinical Culture and stain What is this?

Caustic Agents

Ingestion of THIS or liquids (pH < 2 or pH > 12) produces esophageal lesions ranging from superficial inflammation to deep necrosis with ulceration, perforation, mediastinitis, or peritonitis Factors that determine the severity of injury from a THIS include the amount ingested, the physical state of the agent, and the duration of mucosal exposure time Symptoms of hoarseness, stridor, and dyspnea suggest associated airway injury, while odynophagia, drooling, and food refusal are typical with more severe esophageal injury

Cromolyns

Inhibit mast cell and sensory nerve activation Block trigger-induced asthma Relatively little benefit in the long-term control of asthma due to their short duration of action Low doses of ICS are preferred because they are more effective and have a proven safety profile. What tx is this with asthma?

Klumke paralysis

Injury to 7th & 8th CN and 1st thoracic nerve. Paralyzed hand, flexed wrist, fingers extended ipsilateral horner syndrome (ptosis and meiosis). What brachial plexus injury is this w/newborns?

Limping Child

Inspection Ask older children to point to spot where they hurt Inspect for deformity, atrophy, swelling, erythema, rashes Measure leg lengths True leg length - Anterior superior iliac spine to medial malleolus Apparent leg length - Umbilicus to medial malleolus Measure limb girths Gait evaluation: Standard screening - observation of child's gait in hallway a part of routine evaluation Clinical observation evaluation - observe child's gait in hallway from front, behind and both sides. Observe shoes for wear patterns Perform if: family reports child limping Abnormality is seen on screening exam Physical finding point to a condition that may affect the gait What PE is this for?

Marasmus

Insufficient calorie & nutrient intake What malnutrition protein energy is this in kids?

Kwashiorkor

Insufficient protein intake with adequate carbs Results in hypoalbuminemia and edema - eventually fatty liver disease What malnutrition protein energy is this in kids?

Type 1 Diabetes

Insulin has three key functions: (1) it allows glucose to pass into the cell for oxidative utilization (2) it decreases the physiologic production of glucose, particularly in the liver (3) it turns off lipolysis and ketone production Goal therapies change with age: Children younger than five years - goal is maintenance of glucose 80-180 mg/dL Hemoglobin A1C of 7.5-8.5% School-aged children - goal is maintenance of glucose 80-150 mg/dL Hemoglobin A1C of < 8% Adolescence - Goal is maintenance of glucose 70-130 mg/dL Hemoglobin A1C of < 7.5% Most therapies include multiple injections of fast-acting insulin given with meals in addition to a long-acting basal insulin given at bedtime What tx is this for?

ETT

Intubation is indicated for impending respiratory failure and cardiopulmonary arrest Changes in posture, mental status, speech, accessory muscle use, and RR can indicate progressive ventilatory failure that does not need blood-gas or PEFR confirmation In the final analysis, the decision to intubate rests on a clinician's estimate of the patient's ability to maintain spontaneous respirations Recommendations for weaning and extubation of asthmatic patients have not been validated This means who gets what?

Toxic Appearance

Irritability Inconsolability Poor tone Decreased activity Lethargy Signs include: Tachycardia Tachypnea Signs of Shock Cardiovascular impairment (Cyanosis, poor perfusion) Disseminated Intravascular Coagulation (Petechiae, ecchymosis) This indicates what?

Acyanotic

Is ASD acyanotic or cyanotic?

Acyanotic

Is Atrioventricular Canal Defects acyanotic or cyanotic?

Acyanotic

Is PDA acyanotic or cyanotic?

Cyanotic

Is Total Anomalous Pulmonary Venous Return (TAPVR) acyanotic or cyanotic?

Acyanotic

Is VSD acyanotic or cyanotic lesion?

Acyanotic

Is aortic stenosis acyanotic or cyanotic?

Acyanotic

Is coarctation of the aorta acyanotic or cyanotic?

Cyanotic

Is hypoplastic left heart syndrome acyanotic or cyanotic?

Acyanotic

Is pulmonary valve stenosis acyanotic or cyanotic?

Cyanotic

Is tetralogy of fallot acyanotic or cyanotic?

Cyanotic

Is transposition of great arteries acyanotic or cyanotic?

Cyanotic

Is tricuspid atresia acyanotic or cyanotic?

Cyanotic

Is truncus arteriosus acyanotic or cyanotic?

Confidentiality

Issues to discuss: Risk taking behavior Suicidal or homicidal ideations Physical or sexual abuse If there is an ambiguous situation, consult legal, ethical, or social work Use the time to provide anticipatory guidance to avoid escalation of risk Exceptions to WHAT: Major or impending harm to any person Abuse Suicide Homicide

Picky Eaters

It takes most children 10 tries before accepting a new food Offer new food when your child is hungry and rested. Limit caloric beverages. Eat the food yourself; children love to imitate Have your child help to prepare foods Limit snacks between meals What is this for?

Fire Arms

Kills 700 children <18 annually in US Preventative Advice Keep guns locked Store ammunition in a separate place Never leave a gun unattended Teach children: Never to touch guns without adult help Guns can be dangerous Gun violence on TV and video games is not real life What anticipatory guidance is this?

Legal Rights of Minors

Know your state laws and policies Age of majority: Varies by state, most is age 18 years Exceptions in which healthcare services can be provided to a minor Emergency Care Life threatening condition or condition in which delay in treatment would significantly increase morbidity Diagnosis and treatment of sexuality-related health care Diagnosis and treatment of drug-related health care Emancipated minors Physically and financially independent of family; Armed Forces; married; childbirth Mature minors Able to comprehend the risks and benefits of evaluation and treatment All exceptions should be documented clearly in health record What is this?

Hypothyroidism

Lab eval: Total T4 and FT4 levels are decreased T3 resin uptake (T3RU) is low In primary, the serum TSH level is elevated Circulating autoantibodies to thyroid peroxidase and thyroglobulin may be present Serum GH may be decreased Imaging: Not necessary Bone age is delayed Cardiomegaly is common What is this for?

PROM

Labor ongoing after 24 hours of rupture of membranes Increased risk of maternal or fetal infection and preterm birth Associated with: Group B streptococci Escherichia coli Listeria monocytogenes Mycoplasma hominis Ureaplasma urealyticum Chlamydia trachomatis Anaerobic bacteria of the vaginal flora Risk of fetal infection increases as the length of time between rupture and labor increases, especially if the period is greater than 24 hours What is this?

Congenital Adrenal Hyperplasia

Laboratory Hormonal Studies Genetic Studies Rapid chromosomal diagnosis should be obtained in any newborn with ambiguous genitalia. Urine The diagnosis of P450 oxidoreductase deficiency is best done by gas chromatography/mass spectrometry analysis of urinary steroid metabolites, as serum steroids can be misleading Pathognomonic findings include: increased pregnenolone and progesterone metabolites, increased 17-OHP metabolites, and decreased androgen metabolites Imaging Ultrasonography, CT scanning, and MRI may be useful in defining pelvic anatomy or enlarged adrenals or in localizing an adrenal tumor Contrast-enhanced radiographs of the vagina and pelvic ultrasonography may be helpful in delineating the internal anatomy in a newborn with ambiguous genitalia What dx is this?

Thyroiditis

Laboratory Evaluation: Serum concentrations of TSH, T4, and FT4 are usually normal Some patients are hypothyroid with an elevated TSH and low thyroid hormone levels Thyroid antibodies (antithyroglobulin, antithyroid peroxidase) are frequently elevated Treatment: Full replacement doses of thyroid hormone may decrease the size of the thyroid, but may also result in hyperthyroidism Children with documented hypothyroidism should receive thyroid hormone replacement What is this for?

Hyperthyroidism

Labs: TSH is suppressed T4, FT4, T3, and FT3 are elevated The presence of thyroid-stimulating immunoglobulin (TSI) confirms the diagnosis of Graves disease TSH receptor-binding antibodies (TRaB) are usually elevated Radiologic Eval: Radioactive iodine uptake is increased Bone age may be advanced In infants, accelerated skeletal maturation may be associated with premature fusion of the cranial sutures What dx is this for?

Croup

Laryngotracheobronchitis Most common infection of the middle respiratory tract Older infants and toddlers 6 mo - 3 yr with peak 2nd year Usually follows a common cold Autumn and early Winter Mucosal inflammation, increased secretions with edema, especially subglottic area What is this?

Subacute

Lasting until week 4 Desquamation of skin on hands and feet. Coronary artery aneurysms appear here (highest risk of sudden death) What phase is this with Kawasaki Dz?

Drowning

Leading cause of injury/death in children <4 years old. Kills Three children per day in the U.S.! Prevention Swimming lessons (Infant survival course) CPR ALWAYS use life jackets in lakes, oceans Fence off and lock pools Supervise children in water (pools, lakes, bath etc.)! What anticipatory guidance is this?

Malnutrition

Leads to gut bacterial overgrowth, decreased peristalsis, and diarrhea. As a result, Vitamins and nutrients are poorly absorbed. Therefore more is not better! What is this?

Varicella

Live, attenuated virus for children 12 months of age with booster given at 4-6 years of age All children should have received 2 doses before prekindergarten or school entrance. HIV-infected children (CD-4 count >15%) should receive 2 doses with a 3 month interval between CI/Precautions: Contraindicated in children with leukemia, lymphoma, malignancies of the bone marrow or lymphatic system, and congenital T-cell abnormalities Contraindicated in children receiving immunosuppressive therapy including high-dose steroids Presence of a pregnant mother in the household is NOT a contraindication to a child receiving the immunization Adverse Reactions: Minor infection Injection site inflammation Rash What vaccine is this for children?

Cerebral Palsy

Location: Monoplegia Hemiplegia Diplegia Quadraplegia Motor Dz: Spastic Ataxic Dyskinetic Mixed Type What types and classifications is this for?

Marasmus

Loss of subcutaneous fat Muscle wasting. Emaciated Skin is loose & wrinkled Low body temperature Pale oral mucosa Hair loss Nail changes Irritability or apathy Height is not affected as much as weight. Head circumference is affected, later in the course What presentation is this?

Rubella

Maculopapular rash beginning on face, rapidly spreading to the entire body, and disappearing by day four What is this associated with?

Rubeola (Measles)

Maculopapular rash spreading down from the face and hairline to the trunk As it spreads to the extremities, the rash fades from the face and is completely gone within 6 days Koplik spots are white macular lesions on the buccal mucosa, typically opposite the lower molars Pathognomonic, but not always present

Rubeola

Maculopapular rash spreading down from the face and hairline to the trunk Koplik spots are white macular lesions on the buccal mucosa, typically opposite the lower molars What is this associated with?

Revised Jones Criteria Evidence of recent GABHS infection AND 2 major or 1 major and 2 minor

Major: Polyarthritis Migratory Carditis Pancarditis Tachycardia New murmur Chorea (Syndenham disease) Neurologic and psychiatric signs Erythema marginatum Subcutaneous nodules Minor: Fever >38oC Arthralgias Previous RF Leukocytosis Elevated ESR or CRP Prolonged PR interval What is this with rheumatic fever and the dx?

Genitals

Male: The fetal testicles begin their descent from the peritoneal cavity into the scrotal sack at approximately the 30th week of gestation. The left testicle precedes the right and usually enters the scrotum during the 32nd week. Both testicles are usually palpable in the upper to lower inguinal canals by the end of the 33rd to 34th weeks of gestation. Concurrently, the scrotal skin thickens and develops deeper and more numerous rugae. Female: To examine the infant female, the hips should be only partially abducted, i.e., to approximately 45° from the horizontal with the infant lying supine. Exaggerated abduction may cause the clitoris and labia minora to appear more prominent, whereas adduction may cause the labia majora to cover over them. What is this w/ballard scoring and PE?

ALTE

Management Well appearing, unremarkable Hx and PE Reassurance and warnings - Discuss with pediatrician FIRST!! Significant ALTE - cyanosis, ill appearing, required vigorous stimulation admit for observation, and work up, cardiac and respiratory monitors What is this for?

Head Injuries

Management Cognitive Rest Avoid texting, video games, activities that require attention and concentration Limit television and computer use Decrease school work Physical Rest Avoid any physical activity that exacerbates symptoms Avoid aerobic exercise, weight lifting, household chores, sexual activity Interventions Wear sunglasses Wear earplugs or noise cancelling headphones Medication to alleviate symptoms (NSAIDS, acetaminophen, sleep aids, anxiolytics) Return to School Alert school personnel about injury and initiate slow return Consider forgiveness for missed assignments and more time to complete tests and work Give regular breaks and rest periods Distraction free work areas Avoid standardized test during recovery Monitor for scholastic difficulties for up to 2-3 months post concussion Return to Sports Return to play steps: each step should take 24 hours and the patient MUST be symptom free to continue progression. The patient should also be medication free to start the protocol. Activity should be stopped immediately for any symptoms and can be resumed in 24 hours at the last symptom-free step Non impact aerobic exercise Sport specific exercise (non impact drills) Non contact training drills Full contact practice Return to normal play What is this for w/PPE?

Bronchiolitis

Management ~90% of prior healthy infants managed at home Leading cause of hospitalization of infants Contact Isolation, fever control Fluids (IV/NG tube), humidified oxygen Ventilation required in about 2% of those hospitalized Bronchodilators, steroids not shown to helpful Prevention for infants & children < 2 yo Palivizumab (synagis) RSV-specific antibody monthly IM injections 1 mo prior to and during RSV season (typically November to March) Cost $900/month What is this for?

Croup

Manifestations URI prodrome Low grade fever Cough: SEAL-LIKE BARK Hoarseness Inspiratory stridor Rarely respiratory distress Evaluation History & Exam AP x-ray of neck - steeple sign What is this?

Chlamydia

Maternal WHAT infection at delivery results in colonization of the neonate in 50% of cases Those colonized often develop conjunctivitis soon after birth or pneumonia at 1-3 months of age The nasopharynx is the most commonly infected site Neonatal ophthalmologic prophylaxis is not effective against WHAT

Illicit Drugs

Maternal abuse of psychoactive substances is also associated with increased risks for adverse perinatal outcomes including: Miscarriage Preterm delivery Growth retardation Increased risk for injury to the developing CNS Maternal abuse of inhalants, such as glue, appears to be associated with findings similar to those of fetal alcohol syndrome Cocaine and amphetamine use in pregnancy is associated with an increased risk of: Premature rupture of membranes Preterm delivery Placental abruption Intrauterine growth restriction Neurobehavioral deficits Sudden infant death syndrome Adverse effects associated with opioid use include intrauterine growth restriction, prematurity, and fetal death What is this with pregnancy?

Skin

Maturation of fetal skin involves the development of its intrinsic structures concurrent with the gradual loss of the vernix caseosa. Hence, it thickens, dries and becomes wrinkled and/or peels, and may develop a rash as fetal maturation progresses. These phenomena may occur at varying paces in individual fetuses depending in part upon the maternal condition and the intrauterine environment. What is this w/ballard scoring?

B5

Mature stage; projection of papilla only, due to recession of the areola to the general contour of the breast. What Tanner stage is this?

IV Fluid

Measure electrolytes and glucose when starting IV fluids Recheck electrolytes and glucose every 12-24 hours Base subsequent IV fluids on electrolyte and glucose findings What rules are these for in kids?

Transient Tachypnea of the Newborn

Medical care is supportive, as the retained lung fluid is rapidly absorbed by the infant's lymphatic system. The infant may require some oxygen therapy, fluid management, nutrition, and constant thermal environment. Diuretics are not helpful, Antibiotics not needed, inhaled epinephrine not useful What tx is this for?

Sickle Cell Collapse

Medical emergency 1) Check vital signs 2) Administer high-flow oxygen, 15 lpm 3) Cool the athlete 4) If the athlete is obtunded or as vital signs decline, call 911, attach an AED, start an IV, and get the athlete to the hospital fast 5) Rapid fluid administration needed What is this associated with?

Thyroid Storm

Medical emergency Rare disorder Treatment includes: Cooling blanket for fever Propranolol for tachycardia, hypertension, and autonomic hyperfunction symptoms Iodine used to block thyroid hormone release Cortisol may be used for relative adrenal insufficiency Diuretics and digoxin for heart failure What is this?

Surgical emergency

Midgut volvulus is a WHAT Bowel necrosis results from occlusion of the SMA Mid-gut volvulus is one of the most common indications for small bowel transplant in children, responsible for 10% of cases in a recent series

30 ml/kg 50ml/kg

Mild dehydration over 2 mons and then under 2 mons (infant) need what replacement fluids?

True allergy Lactose intolerance Casein intolerance

Milk allergies are divided into 3 basic types 1. WHAT is this - hives, GI upset, runny nose, eczema. 2. WHAT is this - GI upset, diarrhea. 3. WHAT is this - GI upset, weight loss. Children who do not tolerate cow's milk formula, tend to not be able to tolerate soy formula either. For milk allergy use: hydrolyzed formula (Nutramigen, Alimentum, and Pregestimil) Or Amino Acid formula (Neocate, Elecare, and Nutramigen AA)

Mixed Type Cerebral Palsy

Mixed neurologic involvement of extrapyramidal portions of the brain More than one type of motor pattern is present This term should be used only when one pattern does not clearly dominate Can cause: Athetosis Dystonia Chorea Ataxia Many children with cerebral palsy exhibit subtle signs of some of these disorders, in addition to spasticity Prognosis varies with the anatomy of involvement Associated with more complications, including sensory deficits, seizures, and cognitive impairments What is this?

Inhaled Corticosteroids

Mode of Action Anti-inflammatory agents Reduce inflammatory cell numbers and their activation in the airways The molecular mechanism of action switch off the transcription of multiple activated genes that encode inflammatory proteins such as cytokines, chemokines, adhesion molecules, and inflammatory enzymes Recruitment of HDAC2 to the inflammatory gene complex, which reverses the histone acetylation associated with increased gene transcription Activate anti-inflammatory genes, such as mitogen-activated protein (MAP) kinase phosphatase-1, and increase the expression of β2-receptors Side Effects Local side effects include hoarseness (dysphonia) and oral candidiasis, which may be reduced with the use of a large-volume spacer device What tx is this with asthma?

60 ml/kg 100 ml/kg

Moderate dehydration over 2 mons and then under 2 mons (infant) need what replacement fluids?

Cerebral Palsy

Monoplegia (one limb) Hemiparesis (Hemiplegia): Predominantly unilateral impairment of the arm and leg on the same side Diplegia: Motor impairment primarily of the legs Some will include a limited amount of arm involvement as well Quadraplegia: All four limbs are functionally compromised These are site involvement with what?

Pregnancy

More than 95% of adolescent THIS are unintended Median age of first intercourse is 16 years in the U.S. Half of adolescent THIS occur in the first 6 months after initiation of sexual activity A sexually active female who does not use contraceptives has almost a 90% chance of becoming THIS within a year. Frequently delay seeking a diagnosis until several missed periods have occurred Often present with other symptoms, such as: Vomiting Vague pain Deteriorating behavior Rape or incest should be ruled out in all cases of adolescent THIS

4

Moro present > 4 months Doesn't notice hands No grasp by 3 months No head support by 3 months No babble 3-4 months Eyes crossed most of the time These developmental warnings occur during what month?

Tetralogy of Fallot

Most cases are sporadic Down Syndrome, DiGeorge Syndrome, Maternal Phenylketonuria, maternal rubella May have associated ASD and coronary abnormalities Right → Left Shunt Presentation Pulmonary Stenosis murmur (increase severity murmur becomes shorter and softer) Single S2 Right Ventricular Impulse Left Sternal Border Hypoxic "tet" spells (can be lethal) Restless, agitated, cry inconsolably. Toddler may squat Hyperpnea DOE Cyanosis Clubbing 3-6 months Stroke and brain abcess complications due to right → left shunt Work Up EKG (right axis and RVH) CXR (Boot shaped heart) Echocardiography What is this?

Acute Otitis Media

Most common between ages 6-12 months Sx: Ear pain (pulling on ear), fever, irritability, poor feeding Signs: TM bright red, bulging, occasional perforation with purulence in the canal

Graves Disease

Most common cause of hyperthyroidism in children It is caused by antibodies directed at the TSH receptor that stimulate thyroid hormone production Less common causes of hyperthyroid include: Acute, sub-acute, or chronic thyroiditis Autonomous functioning thyroid nodules Tumors producing TSH McCune-Albright syndrome Exogenous thyroid hormone excess Acute iodine exposure What is this?

Hypertrophic Cardiomyopathy

Most common cause of sudden cardiac death in young athletic patients Presentation Dyspnea on exertion Chest pain Family history of cardiac death prior to age 50 Physical Exam III/IV systolic murmur Murmur that becomes louder with sudden standing or Valsalva maneuver should raise concern for HCM Squatting will soften HCM murmur, but will increase benign murmurs Evaluation Echocardiogram Study of choice to make diagnosis Will show non-dilated, thickened left ventricular wall thickness compared to normal individuals of the same age Treatment Avoid strenuous activity May still participate in low level activity Cardiac surgery vs medical management May consider implantable cardioversion defibrillator (ICD) device ICDs do not allow return to vigorous sports AEDs should be available at all sporting events What is this found on a PPE?

Cerebral Palsy

Most commonly comes in the first 18 months of life Fail to achieve milestones Show abnormalities such as asymmetric gross motor function, hypertonia, or hypotonia-other side not favored is weak What Dx is this?

Fever without a source (FWS) (Alternative terms are fever without localizing signs (FWLS) or fever without a focus, or fever of unknown origin (FUO))

Most commonly, there is no source of fever When the history and physical examination cannot identify a specific source of fever in an acutely ill, nontoxic-appearing child less than three years of age, the illness is often called WHAT? Children under age 28-30 days, approach is more standardized, vs. in children 30-90 days, where clinical exam begins to be more reliable

38 (100.4 Fever) (Temperature in pediatric patients can be measured in a variety of manners: Rectal (using a mercury or digital thermometer) Oral (mercury or digital) Axillary (mercury, digital, or liquid crystal strip) Forehead (liquid crystal strip) Tympanic (using a device that measures thermal infrared energy from the tympanic membrane))

Most experts define fever as a rectal temp of WHAT degrees Celsius or above?

Midgut Malrotation

Most infants present in the first 3 weeks of life with bile-stained vomiting-separate from pyloric stenosis or with overt small bowel obstruction 60% of children present with symptoms of bilious vomiting within 1 month, rest present later in infancy or childhood Older children and adults with undiagnosed malrotation typically present with chronic GI symptoms of nausea, vomiting, diarrhea, abdominal pain, dyspepsia, bloating, and early satiety-like ischemia What is this presentation in children?

PKU

Most infants with classic WHAT that are treated with diet restricted in phenylalanine and begun within the first 10 days of life achieve normal intelligence Sustained control is difficult to achieve after 10 years of age The safe concentration of phenylalanine in older children and adults has not been established Maternal hyperphenylalaninemia is a major problem requiring rigorous management before conception and throughout the pregnancy to prevent fetal brain damage, congenital heart disease, and microcephaly in the fetus

Kawasaki Disease

Most serious aspect of the disease Myocarditis Pericarditis Valvular heart disease Coronary arteritis Usually form after 10th day of illness Highest risk Males <6 months of age Untreated Most resolve within 5 years Thrombosis may result in MI-aspirin inhibits platelets What is this?

Anticholinergics

Muscarinic receptor antagonists such as ipratropium bromide prevent cholinergic nerve-induced bronchoconstriction and mucus secretion They are less effective than β2-agonists in asthma therapy because they inhibit only the cholinergic reflex component of bronchoconstriction Anticholinergics may be used as an additional bronchodilator in patients with asthma that is not controlled by ICS and LABA combinations Side effects: Usually not a problem because there is little or no systemic absorption Dry mouth Urinary retention What tx is this with asthma?

Poisoning

Must determine: All substances of exposure Type of medications Amount of medication Time of exposure What symptoms have occurred By what route did it occur Often incomplete or inaccurate PE: Must include: Vital signs Level of consciousness Pupillary size Presence of muscle fasciculations Bowel and bladder activity-anti his, opioids Cardia arrhythmias Seizures Temperature-serotonin syndrome, neuroleptic malignant syndrome Consider toxidromes Continual reassessment should be done, as some toxin related symptoms are time-dependent Odors Ocular signs Cutaneous signs Oral signs Intestinal Signs-listen 8 mins to see if any bowel movement present Cardiac signs Respiratory signs CNS signs What Hx and PE findings are these for?

Ampicillin & cefotaxime OR ampicillin & aminoglycoside & acyclovir

Neonate - (≤28 days) Common: Group B Streptococcus, E. coli Less common: Listeria monocytogenes, Enterococcus, S. aureus, other Gram negative organisms, Herpes simplex virus What is the antibiotic coverage?

Meconium

Neural stimulation (vagal) of a mature gastrointestinal tract secondary to hypoxia or other stress, causes relaxation of the rectal sphincter and release of intestinal contents. THIS reduces the antibacterial activity in the amniotic fluid, and is an irritant. Airway obstruction - Obstruction results in atelectasis, air trapping , and hyper-distention of alveoli. Surfactant dysfunction - THIS has a higher surface tension than surfactant, causing the surfactant to be stripped away, resulting in atelectasis. Chemical pneumonitis - THIS presence irritates the airways and causes a diffuse pneumonitis quickly.

Baby Bottle Tooth Decay

Never allow your child to fall asleep with a bottle Never give your child a pacifier dipped in anything sweet No Lollipops No juice No soda pop No bottle after 12 months Limit milk to meal times What anticipatory guidance is this?

Baby Bathtub Safety

Never leave baby unsupervised in water! Children can drown in <1" of water Keep your eye & hand on baby at all times Provide secure seating Use spout covers Check water temperature Fill the tub only 2 - 4 inches Teach baby not to stand in the tub Keep electric appliances away from water What anticipatory guidance is this?

Back Neck

Next, inspect the WHAT carefully, for dimples, clumps of hair, skin pigmentation changes, and curvature. The presence of dimples should alert you to the possibility of spina bifida. The WHAT should be evaluated for cystic lesions, and should be very supple. Observe any masses or decreased range of motion.

2

No crying Not tracking objects Not turning head to sound No social smile These developmental warnings occur during what month?

5 months

No food before WHAT! Infants do not have proper digestion enzymes until 5 months old. New studies suggest that introducing grains early and first (cereal) contributes to gluten intolerance, obesity, and allergies. Fats and vegetables should be the first foods! 5-8 months - Pureed avocados and vegetables 6-8 months -Pureed meals, cereal if necessary 9-12 months - Mashed, chopped or soft table food Start drinking from a cup

18-24

No walking 18 mos <15 words 18 mos No 2 word sentences age 2 Cannot follow 1 part commands age 2 These developmental warning signs occur during what months?

ROS

Nutrition: Number and balance of meals; calcium, iron, fiber, and cholesterol intake; body image. Sleep: Number of hours, problems with insomnia or frequent waking. Seat belt or helmet: Regularity of use. Self-care: Knowledge of testicular or breast self-examination, dental hygiene, and exercise. Family relationships: Parents, siblings, relatives. Peers: Best friend, involvement in group activities, gangs, boyfriends, girlfriends. School: Attendance, grades, activities. Educational and vocational interests: College, career, short-term and long-term vocational plans. Tobacco: Use of cigarettes and chewing and smokeless tobacco. Substance abuse: Frequency, extent, and history of alcohol and drug use. Sexuality: Sexual activity, contraceptive use, pregnancies, history of STI, number of sexual partners, risk for human immunodeficiency virus (HIV) infection. Emotional health: Signs of depression, anxiety, and excessive stress. These are questions for what?

Pediatric

ONSET: MOI vs. gradual LOCATION: unilateral vs. bilateral DURATION: constant vs. intermittent CHARACTERISTICS: sharp, aching, what part of the movement hurts? AGGRAVATORS: activity-related? When do they complain about it? RELIEVERS: rest? TREATMENT: Ibuprofen, ice ASSOCIATED SIGNS: redness, swelling, bruising, deformity & how they're holding the affected limb Ortho PE = RIPSS Range of motion Inspection Palpation Strength testing Special testing What consideration is this for?

Alkali

OTC agents like "Liquid Drano," "Liquid Plumr" May be solid, granular, or liquid Tasteless and produce full-thickness liquefaction necrosis of the esophagus or oropharynx can burn the skin, mucous membranes, and eyes Symptoms that are concerning for significant injury esophageal injury include drooling, persistent vomiting, and stridor Respiratory distress may be due to edema of the epiglottis, pulmonary edema resulting from inhalation of fumes, or pneumonia When the esophageal lesions heal, strictures form Increased long term risk of esophageal carcinoma What is this?

Pulmonary Function Tests

Objective measures of lung and airway physiology that can help differentiate obstructive from restrictive lung diseases, measure disease severity, measure disease progression, and evaluate response to therapy Because the range of predicted normal values changes with growth, serial determinations of lung function are often more informative than a single determination Patient cooperation and consistent effort is essential for almost all standard physiologic assessments Lung function measurements in infants and toddlers are available at centers with specialized equipment and expertise The Expert Panel Report (3) recommends pulmonary function testing be performed routinely for evaluation and management of asthmatic children age 5 and older What is this with asthma?

Toxoplasmosis gondii

Obtained from undercooked meats or contact with feces of infected cats Classic neonatal findings include: Hydrocephalus Chorioretinitis Intracerebral calcifications Other findings include: SGA Early onset jaundice Hepatosplenomegaly Maculopapular rash Seizures possible Therapy includes pyrimethamine combined with sulfadiazine What maternal infection is this?

Congenital Heart Disease

Occur in 8 per 1000 births. Asymptomatic to fatal in presentation. Present later in life sometimes-bad stuff appear very quickly and short amount of time to take care of pt Can be associated with chromosomal abnormalities and maternal metabolic diseases. *Down syndrome Turner Syndrome Trisomy 13-15 and 17-18* Hurler's Syndrome Homocystinuria Type II glycogen storage disease Maternal Diabetes What is this associated with in Peds?

Neonatal Graves Disease

Occurs in about 1% of infants born to mothers with Graves disease Maternal TSH receptor antibodies cross the placenta and stimulate excess thyroid hormone production in the fetus and newborn can be associated with irritability, IUGR, poor weight gain, flushing, jaundice, hepatosplenomegaly, and thrombocytopenia may develop several days after birth, especially if the mother was treated with PTU (which crosses the placenta) gradually resolves over 1-3 months as maternal antibodies decline What is this?

Intestinal Atresia

Occurs in several forms in which one or more segments of the bowel may be missing completely or in remnants that are cord-like Presents with polyhydramnios, abdominal distention, and bilious vomiting The prevalence is 1 in 1,500 live births Multiple sites in the intestine may be affected and the overall length of the small intestine may be significantly shortened

Maternal Phenylketonuria

Offspring of WHAT mothers may have transient hyperphenylalanemia at birth Elevated maternal phenylalanine causes: Mental retardation Microcephaly Growth retardation Congenital heart disease or other malformations The risk to the fetus is lessened considerably by maternal phenylalanine restriction throughout pregnancy and optimally started before conception

Sinusitis

Often a complication of the common cold or allergies Bacterial causes include S. pneumoniae, H. influenzae, Moraxella catarrhalis, S. aureus, other streptococci and anaerobes Maxillary and ethmoid sinuses are present at birth. Maxillary sinuses become pneumatized-air filled at age 4. Frontal sinuses begin to develop around age 7. The sphenoid sinuses are present by age 5. Manifestations: Persistent mucopurulent unilateral or bilateral rhinorrhea Nasal stuffiness Cough, esp. at night Nasal Quality to Voice Halitosis Facial Swelling-more severe Facial Tenderness/Pain Headache ? Fever-severe Pain radiating into teeth-severe Exam: Must look in the nose!!! Laboratory and Imaging Culture of nasal mucosa-NOT useful-after failing abx therapy Sinus aspirate culture most accurate-after failing abx therapy Transillumination Plain film-after failing abx therapy CT MRI What is this?

Pyloric Stenosis

Olive shaped mass non-bilious vomiting-not passing to duodenum What is this in children??

Obesity and DMII

On the rise in the U.S. Cheap foods are generally not healthy!! TV, computers, and video games have replaced exercise and outdoor play. Cultural acceptance has made THIS OK Clinicians often document without reinforcing findings. How to approach...be sensitive BUT HONEST and CLEAR What is this in kids?

Congenital Hypothyroidism

Once detected, must start therapy right away T4 is instituted at a dose of 10-15 μg/kg per day, and the dose is adjusted by close monitoring of TSH levels T4 requirements are relatively great during the first year of life, and a high circulating T4 level is usually needed to normalize TSH Goal is to have serum free T4 rapidly into the upper half of the range of normal Prognosis is good if treatment started early What Tx is this for?

Normal

Onset 10-14 months Normal mature adult gait pattern occurs at about 3 years Prior to 3 years gait is wide based with externally rotated legs Mature gait is approximately 60% stance phase and 40% swing phase What type of gait is this?

Galactosemia

Onset of the severe disease is marked in the neonate by: Vomiting Jaundice (both direct and indirect) Hepatomegaly/Liver failure Rapid onset of liver insufficiency after initiation of milk feeding Hepatic cirrhosis is progressive Cataracts usually develop within 2 months in untreated cases but usually reverse with treatment Without treatment, death frequently occurs within a month, often from Escherichia coli sepsis What clinical presentation is this for?

Failure to thrive

Organic + inorganic Significantly compounded situation Both must be dealt with Seen in chronically ill or very sick premature babies. PRESENTATION - Non linear growth Weight loss Skin and hair problems Recurrent infections Hepatomegaly Edema Reduced muscle mass Loss of cutaneous fat Developmental delays What is this for?

Failure to thrive

Organic: Congenital - Ex: perinatal infection, chromosomal abnormality, cleft palate Neurologic - Ex: cerebral palsy Cardiopulmonary - Ex: CF, CHD GI - Ex: malabsorption, structural problems, food intolerance/allergy Renal - UTI, RTA, diabetes insipidus, CRF Hematologic - sickle cell disease, iron def. anemia Endocrine - DM, hypothyroidism, growth hormone deficiency Infectious - HIV, TB, GI diseases Miscellaneous - lead poisoning, collagen vascular diseases, malignancy Non-organic: Causes: Financial difficulties Improper feeding technique (watery formula) Problems nurturing (lack of bonding) Environmental stress Parental dietary beliefs/lack of knowledge Parental depression / eating D/O Neglect What are these causes of?

1500mL + 20mL/kg for every kg over 20kg

Over 20kg child needs what dosing of daily IV maintenance fluid requirement?

Hypothyroidism

Overt WHAT is defined by an elevated serum TSH level with a depressed FT4 level The condition in pregnancy has consistently been associated with an increase in complications such as: Spontaneous abortion Preterm birth Preeclampsia Placental abruption Impaired neuropsychological development in the offspring Many of the symptoms of WHAT mimic those of normal pregnancy, making its clinical identification difficult

Pneumococcal

PCV13(Prevnar 13) and PPSV23 (Pneumovax 23) Both are recommended for adults over the age of 65 with a 6-12 month interval for most. PCV13 (Prevnar) given at 2, 4, 6, and 12-15 months of age A history of invasive pneumococcal disease is NOT a contraindication to vaccination-still give it once illness resolved. CI/Precautions: Vaccination should be deferred during moderate/severe illness with or without a fever Adverse Effects: Fever, injection site reaction, irritability, increased sleep Small increased risk of febrile seizures if co-administered with influenza vaccine Fewer than 1% develop systemic effects What vaccine is this?

Limping child

Palpation Palpate suspected joints for tenderness Attention to hips, SI joints, greater trochanters, knees and ankles Test knees for effusion Range of Motion Assess motion, laxity, stiffness, and guarding of all joints Neurological Examination Lower extremity strength Sensation, proprioception Deep tendon reflexes Special Tests Hip range of motion: Prone internal and external rotation is the most sensitive marker of hip pathology (log roll test), good for FABER test: sacroiliac stress, iliotibial band syndrome FADIR test: acetabular impingement, piriformis syndrome, labral tears Galeazzi Test: Potential congenital hip malformation Ober test: iliotibial band syndrome What PE is this for?

Congenital Adrenal Hyperplasia

Parenteral or oral hydrocortisone (30-50 mg/m2/d) suppresses abnormal adrenal steroidogenesis within 2 week When adrenal suppression has been accomplished, as evidenced by normalization of serum 17-hydroxyprogesterone, patients are placed on maintenance doses of 10-15 mg/m2/d in three divided doses Dosage is adjusted to maintain normal growth rate and skeletal maturation Children with CAH usually receive mineralocorticoid and salt replacement Fludrocortisone, 0.05-0.15 mg, is given orally once a day or in two divided doses Mineralocorticoid requirements change during life and are higher in children Therapy should be continued throughout life in both males and females Consultation with a urologist or gynecologist experienced in female genital reconstruction should be arranged as soon as possible during infancy Treatment goals in CAH are to replace deficient steroids with the smallest dose of glucocorticoid that will produce normalization of growth velocity and skeletal maturation by adequately suppressing excess build-up of androgen precursors Mineralocorticoid replacement sustains normal electrolyte homeostasis, but excessive mineralocorticoids cause hypertension and hypokalemia What tx is this for?

Preventative Screening and Anticipatory Guidance

Part of the well-child exam Screening for: TB , lead, anemia Vision & Hearing Scoliosis STI, metabolic disorders, cholesterol, drug use... Recommendations for the Parent: Age appropriate guidance Inform when milestones are met (reassurance) Our job as PAs is to screen at age appropriate intervals and offer appropriate prevention, intervention , and guidance What is this?

Hypoparathyroidism

Pathogenesis: Trauma, surgical destruction, isolated autoimmune destruction Findings: Symptoms of hypocalcemia Laboratory findings: Calcium: Low Phosphorus: High Alkaline Phosphatase: Normal or low Serum PTH: Low Serum 1,25 OH vitamin D: Low What is this?

Asthma

Pathologic features of THIS include: Shedding of airway epithelium Edema Mucus plug formation Mast cell activation Collagen deposition beneath the basement membrane Airway inflammation contributes to airway hyper-responsiveness, airflow limitation, and disease chronicity Persistent airway inflammation can lead to airway wall remodeling and irreversible changes

Type 1 Diabetes

Pathophys: Insulin deficiency usually first causes postprandial hyperglycemia, then fasting hyperglycemia Ketogenesis is a sign of more complete insulin deficiency Lack of suppression of gluconeogenesis and glycogenolysis further exacerbates hyperglycemia while fatty acid oxidation generates the ketone bodies (beta-hydroxybutyrate, acetoacetate, and acetone) Protein stores in muscle and fat stores in adipose tissue are metabolized to provide substrates for gluconeogenesis and fatty acid oxidation What is this for?

Cerebral Palsy

Pathophys: is caused by injury to the brain that happens usually during pregnancy but sometimes shortly after birth. Common risk factors include prematurity, infection, inflammation, trauma, and coagulation disorders leading to intrauterine or perinatal strokes. The most common risk factor is *prematurity* Traumatic brain injury, including abusive head trauma ("shaken baby" syndrome), is also a significant cause Risk Factors: Before pregnancy: Maternal thyroid disorder History spontaneous abortion / stillbirth Family history of mental retardation Pregnancy and Birth: Low Socioeconomic status Prematurity Maternal seizures Treatment with thyroid hormones, estrogen, or progesterone Pregnancy complications Polyhydramnios Eclampsia 3rd trimester bleeding Multiple births Fetal Growth Retardation Abnormal fetal position Congenital malformation Postnatal: Newborn hypoxic-ischemic or bilirubin (kernicterus) encephalopathy Intracranial hemorrhage Infection What is this?

Oral corticosteroids

Patients demonstrating a good response to initial therapy in the ED may be discharged home with close follow-up The patient should demonstrate: Significant improvement in breathlessness Improved air movement on physical examination A FEV1 or PEFR ≥70% of predicted or personal best Observation for 60 minutes after the last β-agonist dose helps ensure stability prior to discharge In general, patients should be discharged on WHAT Inhaled corticosteroids (ICSs) should be continued (or even initiated)

Acetaminophen

Patients may complain of nausea and vomiting shortly after a toxic ingestion, but may also be asymptomatic Signs and symptoms of acute liver injury occur within 36 hours after ingestion Occasionally, patients present to the emergency department when they develop the signs of hepatotoxicity, not realizing that the large ingestion of an THIS based product is the etiology

Salicylate

Patients usually have signs of: Tachypnea Fever Vomiting Diaphoresis Alkalosis (Early) and Acidosis (Late) In severe cases, disorientation, convulsions, and coma may develop The severity of acute intoxication can, in some measure, be judged by serum THIS levels High levels are always dangerous irrespective of clinical signs, and low levels may be misleading in chronic cases Other laboratory values usually indicate metabolic acidosis despite hyperventilation, low serum K+ values, and often abnormal serum glucose levels.

Combo

Pediarix-DTaP, Hep B and IPV Kinrix-DTaP and IPV Pentacel-DTaP, IPV, and Hib ProQuad-MMR and Varicella What vaccines are these?

Abductor Lurch/Trendeleburg Gait

Pelvis tilts away from affected hip during stance phase Torso appears to shift toward the pathological side to compensate for abductor weakness What type of gait is this?

G4

Penis further enlarged in length and girth with development of glans. Testes and scrotum further enlarged. The scrotal skin has further darkened What Tanner stage is this in boys?

Otitis media

Perforation Petrositis Mastoiditis Language delay Hearing loss Cholesteotoma Intracranial abscess These are complications of what?

Abuse

Physical Sexual Emotional Neglect Risk Factors Substance abuse Poverty and economic strains Parental capacity and skills Domestic violence Gender: With physical abuse, women are the more likely perpetrators However, serious injuries were more commonly related to men abusers (fathers and maternal boyfriends) These are types of what?

Head Injuries

Physical Exam Sideline/Initial assessment SCAT - Sports Concussion Assessment Tool Neurological Exam Balance - Romberg sign, postural instability, unsteadiness Cranial nerves Deep tendon reflexes - Hyperreflexia or Babinski reflex suggests upper motor neuron lesion Finger-to-nose test - Abnormal findings suggest coordination deficit Gait - Ataxia may suggest cerebellar dysfunction Mental status - Prolonged loss of consciousness (60 sec); somnolence or confusion; disorientation; deficit in language, speech, or long term memory Muscular strength - Weakness or unequal strength, decreased tone, involuntary movements significant for basal ganglia or cerebellar injury Sensory assessment of dermatomes - spinal nerve root injuries Imaging Guidelines (American Academy of Pediatrics and American Academy of Family Physicians) Patients with loss of consciousness of greater than 60 second, evidence of skull fracture, or focal neurologic findings Consider imaging or observation if patient has brief loss of consciousness Non specific signs (such as immediate seizures, headache, vomiting, lethargy) increase likelihood of intracranial injury CT is initial diagnostic tool of choice MRI is more effective at determining long term effects What is this for with PPE?

Pre-Participation Exam (PPE)

Physical Exam Thorough general exam Vital signs Inspection- focus on physical deformities, signs of Marfan syndome Complete cardiovascular exam Pulmonary exam Abdominal exam Musculoskeletal screening exam (ROM & strength) Imaging studies and labs are not routinely needed Referrals before participation: Early fatigue, dizziness, syncope, chest pain, shortness of breath, or palpitation with exercise Family history of sudden death or significant cardiovascular disease Physical signs of Marfan syndrome Significant head or spine injury Significant musculoskeletal problems Uncontrolled asthma New or undiagnosed murmur Previous heat related illness What is this related to?

Newborn

Physical Exam: Weight check- chart Birth history and physical exam Patient Education/anticipatory guidance: Safety- car seat, hot beverages, rolling off table, 2nd and 3rd hand smoke , sleep position, crib safety (No fluffy things) Warnings- fever-above 101 or give tylenol, when to call Cord care-circumcision area Feeding advice-breast/bottle Sleeping advice Elimination advice-poop-green okay Any parent questions? What visit is this?

Juvenile Rheumatoid Arthritis (JRA)

Physical Examination Evaluate joints for swelling, effusion, warmth, limited range of motion and muscle atrophy Diagnostic Tests Erythrocyte sedimentation rate (ESR) is often normal Antinuclear antibody (ANA) if positive often indicates a tendency for uveitis Treatment NSAIDS DMARDS*- methotrexate (Rheumatrex), leflunamide (Arava) Biologics* - etanercept (Enbrel); infliximab (Remicade); adalimumab (Humira), etc. Oral steroids - short term use only Refer to pediatric rheumatologist What is this?

Septic Arthritis

Physical Examination Guarding and exquisite pain with ROM of joint Erythema, warmth, effusion Fever Labs CBC with differential Sed Rate CRP Imaging X-ray - probable joint effusion, rule out other causes Procedure Joint aspiration *Aspiration and Fluid Analysis - gold standard for diagnosis Evaluate CBC, glucose, Gram stain, and culture Hip - ultrasound guided Fluid WBC >50,000 Send for culture and sensitivity Initiate treatment: <12 months gram pos: oxacillin, clinda, 1st gen cephalosporin, gentamycin, ceftriaxone 6mons-5 years strep pneumo, group A strep, H flu: oxacillin, clinda, 2nd or 3rd gen cephalosporins 5-12 years staph aureus: oxacillin, clinda, 1st gen cephalosporin 12-18 years staph aureus, N gonorrhea: oxacillin, cephalosporins What is this for?

Respiratory Distress Syndrome

Physical signs of THIS can include some or all of the following: Tachypnea Expiratory "grunting" Subcostal and intercostal retractions Cyanosis Nasal flaring Apnea Hypothermia

School Age Children

Poor grades Difficulty expressing self Trouble making friends Fights with others Temper tantrums Frequently acting out Very poor handwriting Lack of interests These warnings signs occur in whom?

Failure to thrive

Poor growth during infancy and childhood leads to developmental delays and poor psychosocial functioning. First year of life is a time of critical brain growth, especially omega 3s! Organic and non-organic causes failure of parent to offer adequate calories failure of child to take in adequate calories failure of child to retain or utilize sufficient calories What is this?

1

Poor suck Slow feeding No reaction to light Stiff/floppy No response to noise These are developmental warnings during what month?

G1

Preadolescent. Testes, scrotum, and penis are about the same size and proportion as in early childhood What Tanner stage is this in boys?

P1

Preadolescent. The vellus is no further developed than that over the abdominal wall (ie, no pubic hair) What Tanner stage is this in boys?

B1

Preadolescent; elevation of papilla only What Tanner stage is this?

P1

Preadolescent; the vellus over the area is no further developed than that over the anterior abdominal wall (ie, no pubic hair) What Tanner stage is this in girls?

Atrioventricular Canal Defects

Presentation CHF in 6-8 weeks of life. Trouble feeding, trouble growing Prominent S2 Down Syndrome (Trisomy 21) very common Work Up Echocardiography CXR Cardiomegaly, increased vascularity EKG Left Axis, LVH What is this?

ASD

Presentation Even Large ASD with big shunts are rarely symptomatic. Right Ventricular Impulse at LLSB Fatigue, palps, atrial arrythmia, *stroke*, syncope, heart failure Grade I-II SEM with a ***Fixed Split S2 May Radiate to Left Axilla or Back Work Up EKG (Right Axis, RVH) CXR (Cardiomegaly, Prominent pulmonary artery-back from left pressure goes up there and have to go through pulm artery) Echocardiogram What is this?

VSD

Presentation Small VSD = Asymptomatic with a loud murmur ***Pansystolic Murmur LLSB Moderate to Large VSD = CHF, Fatigue, Diaphoresis with feeding, Poor Growth, breathing faster and harder. Large shunts can have a Mid-diastolic Murmur at apex and Thrill Work Up ECG (small = Normal) (Larger = LAE and LVH CXR (Cardiomegaly) Echocardiogram (Shunt and elevated RVSP[pulmonary htn]) What is this?

PDA

Presentation Small = asymptomatic Larger = CHF over first 6-8 weeks-pressure and volume of fluid back in lungs goes up and get CHF and pulm edema tachypnea, diaphoresis, difficulty with feeding, weight loss, cough, respiratory infections, pneumonia Widened Pulse Pressure ***Continuous Machine like murmur at left infraclavicular space sometimes with thrill present Work Up EKG (usually normal, LVH) CXR (usually normal, or pulmonary artery silhouette, increased pulmonary vascularity. ) Echocardiogram What is this?

Exercise Induced Asthma

Prevention During PPE discuss daily control and trigger avoidance Undiagnosed athletes or those who are poorly controlled should not participate until symptoms are controlled at rest Structured warmup protocol before sport participation can help prevent attacks Athlete may experience a refractory period of as long as 2 hours, potentially decreasing the risk of an exacerbation or decreasing reliance on medications Sports medicine team should provide education to assist the athlete in recognizing signs and symptoms, understanding how to use medication as prescribed, and how to use spirometry What is this?

Respiratory Distress Syndrome

Prevention and prediction of premature delivery. Antenatal glucocorticoids Delivery and resuscitation, if necessary. Surfactant replacement therapy. Assisted ventilation and sedation. Oxygen and continuous positive airway pressure. Supportive therapy: Temperature regulation Fluids and nutrition Circulation and anemia Support of parents and family What is this tx for?

Meconium aspiration syndrome

Prevention is the most important part of treatment. Obstetricians should monitor fetal status in an attempt to prevent events that might cause meconium to be discharged. When intervention is necessary: Oxygen delivery, respiratory care, blood pressure and heart rate should be monitored frequently and carefully, broad spectrum antibiotics What tx is this for?

Low and Very Low Birth Weight

Previous LBW birth Low SES Low level of maternal education No antenatal care Maternal age younger than 16 years or older than 35 years Short interval between pregnancies Cigarette smoking Alcohol and illicit drug use Physical or psychological stresses Unmarried Low pre-pregnancy weight (<100 lbs.) Poor weight gain during pregnancy (<10 lbs.) African American race (twice as likely as Caucasian females What risk factors are these associated with?

Type 1 Diabetes

Previously referred to as juvenile-onset diabetes Autoimmune destruction of insulin-producing beta islet cells of the pancreas An unknown environmental insult probably triggers the autoimmune process in the setting of diabetes susceptible genes Antibodies to islet cell antigens may be seen months to years before the onset of beta cell dysfunction When 80-90% of the beta cell mass has been destroyed, the remaining beta cell mass is insufficient to maintain euglycemia and the clinical manifestations of DM develop What classification is this for?

Herpes Simplex Virus

Primary: Women with no evidence of prior infection and is seronegative to both HSV-1 and HSV-2 Poses the greatest risk to the fetus Risk of neonatal infection approaches 50%, much less in recurrent Most infants do well with localized herpes infection, but infants with disseminated infections do poorly Consider disseminated with sepsis, liver dysfunction, negative cultures Encephalitis, localized or disseminated disease, skin vesicles, *Keratoconjunctivitis* C section indicated if herpes lesions are identified on the cervix, in the vagina, or on the vulva at the time of labor What maternal infection is this?

Rubella (German Measles)

Prodromal nonspecific respiratory symptoms and adenopathy (postauricular and occipital) Maculopapular rash beginning on face, rapidly spreading to the entire body, and disappearing by day four is transmitted by aerosolized respiratory secretions Patients are infectious 5 days before until 5 days after the rash Teratogenic

Cushing Disease

Progressive central or generalized obesity, marked failure of longitudinal growth, hirsuitism, weakness, nuchal fat pad (buffalo hump), acne, striae, hypertension Relates to suppression of adrenal function Treatment is directed at etiology Excision of autonomous adrenal, pituitary, or ectopic ACTH-secreting tumor What is this?

Pyloric Stenosis

Projectile postprandial vomiting usually begins between 2 and 4 weeks of age Vomiting starts at birth in about 10% of cases and onset of symptoms may be delayed in preterm infants Vomitus is never bilious - the gastric outlet obstruction is proximal to the duodenum Infants are usually ravenously hungry and nurse avidly early in the course, but become more lethargic with increasing malnutrition and dehydration The upper abdomen may be distended after feeding, and prominent gastric peristaltic waves from left to right may be seen An oval mass, 5-15 mm in longest dimension can be felt on deep palpation in the right upper abdomen, especially after vomiting This palpable hypertrophied pylorus is described as an "olive" Only present in 13.6% of patients studied What is this in children?

B4

Projection of areola and papilla to form a secondary mound above the level of the breast What Tanner stage is this?

Heat Related Illness

Prompt cooling is the cornerstone of heatstroke treatment Immediate initiation of rapid and effective cooling is crucial in a patient with heatstroke. Initiate cooling while the patient is awaiting transport Cooling Methods: External methods include evaporative and immersion cooling Evaporative cooling - cool water mist is sprayed on patients skin while warm air is fanned over the body. Cooling rates with this technique have been measured at 0.31°C (0.56°F) per minute Immersion cooling - ice bath or by using cooling blankets in conjunction with ice packs placed on the axilla, groin, neck, and head Concern for peripheral vasoconstriction and shivering when skin temperature is cooled below 30°C (86°F) Concern for difficulty with access to immersed patient in emergencies, i.e. cardiac arrest. Bradycardia as a result of the diving reflex is not uncommon Internal cooling methods Minimally invasive gastric, bladder and rectal cold water lavage Very effective at rapid temperature reduction What is this tx for?

Child Abuse

Protect internet viewing Know who they are with Teach children that NO ONE touches your private body parts Teach them to "Yell and Tell" Be alert for: Premature sexual understanding. Someone who shows extreme interest in your child Behavior changes or change in school performance Hotline 1-800-4-A-CHILD® (1-800-422-4453). What is this preventing?

Congenital Pneumonia

Pulmonary injury in neonatal pneumonia is caused directly by invading microorganisms or foreign material. The neonatal host defense system may not have the appropriate response. The activated inflammatory response product may directly injure tissues and alter the metabolic components. Gas exchange may be impaired as a result of the airways having more resistance. As the myocardium works harder to overcome the effects of pulmonary resistance, the lungs may be less able to add oxygen and remove carbon dioxide. Heart failure may occur as lung efficiency decreases. may originate at three different times: 1.True congenital pneumonia is already established at birth. 2. Intrapartum pneumonia is acquired during passage through the birth canal. 3. Postnatal pneumonia originates in the first 24 hours of life, but begins AFTER the infant leaves the birth canal What pathophys is this for?

Adolescents

Pulmonary: Asthma Cystic fibrosis Neuromuscular Cerebral palsy Mental retardation Seizure disorder Auditory visual defects Traumatic paralysis Scoliosis Migraine Endocrine: Diabetes mellitus Obesity Anorexia/Bulimia Nervosa Acne Dysmenorrhea These are chronic illnesses leading to morbidity in whom?

6 5 12 24 6 6

Questionnaire: At ALL well child visits WHAT months up to age WHAT. Blood Lead Test: If answers indicate the child is not at risk, screen at WHAT and WHAT months If answers indicate the child is at risk, screen starting at WHAT months and every WHAT months thereafter Any history suggesting lead exposure should be followed with lead test

Influenza ("Persons who are able to eat lightly cooked egg (e.g., scrambled egg) without reaction are unlikely to be egg-allergic. Persons who have experienced only hives after exposure to egg should receive any licensed, recommended influenza vaccine age-appropriate influenza vaccine (i.e., IIV or RIV). Persons reporting symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may also receive any licensed and recommended influenza vaccine that is otherwise appropriate. Additionally, for these persons, vaccine should be administered in an inpatient or outpatient medical setting and supervised by a health care provider who is able to recognize and manage severe allergic conditions. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of causing the reaction, is a contraindication to future receipt of the vaccine.")

Recommended for ALL persons 6 months of age and older without contraindications. High risk groups: Children 6-59 months, Adults over 50, BMI over 40, asthma, DM I and II, CAD, COPD, renal disease, HIV, immunocompromised, pregnant or will be during flu season, Nursing Home residents, Caretakers, close contacts Should be offered at least by the end of October, if possible, but continue through the season LAIV not recommended for any population during the 2017-2018 flu season Has the child received ≥2 doses of trivalent or quadrivalent vaccine before July 1, 2017? (*Note: Doses need not have been given during same or consecutive seasons) If Yes: 1 dose of2017-18 vaccine If No: 2 doses of2017-18 vaccine(administered ≥4 weeks apart) What vaccine is this for children?

Hep A

Recommended for all children 12-23 months of age Following groups 1. travelers to countries with moderate-high rates of THIS 2. children with chronic Hep B or Hep C infections or other chronic liver disease 3. children with clotting disorders 4. adolescent and adult males who have sex with men 5. persons with an occupational exposure to THIS 6. illegal drug users 7. all unvaccinated who are in close personal contact with international adoptees from countries with THIS Considered for unimmunized 2-18 year olds, without above risk factors 1st dose at 12-23 months with 2nd dose 6-18 months after the initial dose Postexposure prophylaxis recommended for household or sexual contact and for daycare staff and attendees in outbreak situations Contraindications-NOT administered to children with hypersensitivity to neomycin Precuation-pregnancy and mod-severe illness Adverse Effects-pain, swelling, induration, headache, loss of appetite What vaccine is this for children?

Neck Chest and Lungs

Redundant neck skin or webbing, with a low posterior hairline, is seen in Turner syndrome Check for masses Check for fractured clavicles Check air entry bilaterally and the position of the mediastinum by locating the point of maximum cardiac impulse and assessment of heart tones Expiratory grunting and decreased air entry are observed in hyaline membrane disease. Rales are not of clinical significance at this age What PE is this w/newborn?

Gastroesophageal Reflux

Reflux of gastric contents into the esophagus occurs during spontaneous relaxations of the lower esophageal sphincter that are unaccompanied by swallowing Low pressures in the lower esophageal sphincter or developmental immaturity of the sphincter are not causes of THIS in infants Bile-stained emesis in an infant requires immediate evaluation as it may be a symptom of intestinal obstruction (malrotation with volvulus, intussusception) What is this?

9

Refuses to cuddle No affection for caregiver No objects to mouth Cannot roll over Cannot sit w/o support No peek-a-boo These developmental warnings occur during what month?

Temper Tantrums

Remain calm Don't overreact Don't give in DO NOT PROVIDE AN AUDIENCE Remove child from situation Pick your battles (safety first!) Don't bribe! Avoid triggers/give choices Praise good behavior What is this related to?

Pertussis

Respiratory tract infection caused by Bordetella pertussis Highly contagious Face to face Confined spaces Contact with contaminated respiratory fluids 80-90% of exposed hosts develop illness! As a result of infection, a mucopurlosanguinous exudate forms in the respiratory tract. This compromises small airways resulting in atelectasis, cough, pneumonia, and in severe cases cyanosis. The lung parynchema is not invaded. What is this?

Hypoxic tet spells (can be lethal)

Restless, agitated, cry inconsolably. Toddler may squat What is this with tetralogy of fallot?

48

Return office visit Early outpatient follow up is recommended for all infants discharged BEFORE WHAT hours of age. A feeding history and physical assessment should be done at discharge. Careful attention should be paid to the amount of food the infant is taking, the frequency of elimination, and the frequency of feedings. The unclothed weight should not be less than 8-10% less than birth weight. Assessment of hydration, and general well-being is also done at this time. Make sure to address any concerns of the parents. Infants should be back to birth weight at the 2 week check up. Some pediatricians and hospitals give parents a booklet on infant care and feeding so they have a reference after going home.

Hearing and Vision

Risk assessment screening at every well child visit until age 3 and again at age 7- followed by testing if necessary Performed at age Newborn-4-6-8-10-12 regardless of risk What is this testing for?

Status Asthmaticus

Risk factors: Characteristics of prior exacerbations that predict a fatal or near fatal attack include: Intubation Hypercapnia Barotrauma Hospitalization despite corticosteroids Psychiatric illness Medical noncompliance Substance abuse Alcohol ingestion Excessive, long-term use of β-agonists These risk factors are for what?

Congenital Pneumonia

Risks: Preterm Labor Premature ROM Prolonged ROM Maternal fever Uterine tenderness Foul smelling AF Maternal GU infection Hx of neonatal infection Non-reassuring fetal well-being Fetal tachycardia Breech presentation Meconium in AF Maternal illness Maternal obesity Maternal congenital cardiopulmonary disease Maternal smoking Pulmonary Clinical findings: Tachypnea Expiratory grunting Intercostal and subcostal retractions Profuse airway secretions Cyanosis Asymmetry of breath sounds Systemic Clinical findings: Unstable temperature Skin rash Rapid-onset, progressive jaundice Glucose intolerance Poor perfusion Abdominal distention Poor urine output Increased risk of other infection associated pathologies: Pleural effusion Empyema Systemic infection Pulmonary HTN Air leak syndrome/airway injury Obstructive secretions Hypoperfusion Chronic lung disease End-organ-damage What is this?

Blueberry muffin rash

Rubella infection is associated with what rash in an infant?

Adolescent Ejection Murmur

SEM LUSB Softer when upright What innocent cardiac murmur is this?

Still Murmur

SEM (age 3-6) LLSB Decreases when upright What innocent cardiac murmur is this?

No 1 hour 2 hours

Screen time: TV, Video Games, I pad, Smart phones, and computer. Too much screen time can: Affect sleep Increase hyperactivity, anxiety, and depression Raise risk of obesity Children under age 2 should have WHAT screen time. Despite what ads may say, videos that are aimed at very young children do not improve their development. Limit screen time to WHAT a day for children age 2-7 Limit screen time to WHAT a day for children age 8+

Gonorrhea

Screen women early in pregnancy Fetal risks for WHAT include: Gonococcal Ophthalmia Sepsis Meningitis Systemic antibiotics are needed for treatment All neonates receive routine prophylaxis with sterile ophthalmic ointment containing erythromycin or tetracycline, which is generally effective in treatment of WHAT

Steppage

Seen in patients with foot drop secondary to peroneal nerve injury or any condition causing weakness of the anterior tibialis muscle What condition might you expect to see this gait pattern in for younger patients? Muscle strain, shin splint, Achilles strain, calf strain What type of gait is this?

10-24

Separation anxiety is considered normal during what months?

Emergent irrigation and drainage

Septic arthritis of the HIP requires WHAT to minimize risk of septic necrosis of the femoral head Empiric antibiotic therapy should begin as soon as possible after diagnosis Specific antibiotic treatment should be tailored depending on culture results

Respiratory Failure

Several pathophysiologic mechanisms appear to be responsible for ventilatory failure in acute asthma Intrinsic PEEP is a threshold pressure that must be overcome before inspiratory flow occurs, increasing inspiratory work of breathing Increased airway resistance and decreased lung compliance further increase work Increased mechanical loads are placed on a diaphragm that is placed in a disadvantageous position by lung hyperinflation, and at the same time circulatory abnormalities may result in hypoperfusion of the exercising respiratory muscles In the end, strength is inadequate for load and hypercapnia ensues, which further decreases diaphragm force generation What is this?

ICU

Severe Asthma: Patients with severe airflow obstruction demonstrating a poor response to initial therapy and patients who deteriorate despite therapy should be admitted to WHAT Other indications for WHAT admission include: Respiratory arrest Altered mental status Hypercapnia Arrhythmias Need for frequent inhaler treatments Admission is also recommended when there is a harmful home environment or medical noncompliance

90 ml/kg 150 ml/kg (infants require formula/breast milk in addition to IV fluids)

Severe dehydration over 2 mons and then under 2 mons (infant) need what replacement fluids?

Antalgic

Shortening of stance phase of affected limb Pain in affected limb with weight bearing forces patient to quickly return to opposite leg support phase What type of gait is this?

Addison's Disease

Signs and symptoms that may indicate adrenal crisis: Hypotension or shock, particularly is disprop to apparent underlying illness Serum electro abnormalities Hyponatremia w/wout hyperkalemia Metabolic acidosis Hypoglycemia Vomiting and diarrhea, sometimes with severe abdominal pain or unexplained fever, wt loss, and anorexia What is this?

Hyperthyroidism

Signs include: Tachycardia Systolic hypertension Increased pulse pressure Tremor Proximal muscle weakness Moist, warm, skin Thyroid storm is a rare condition characterized by fever, cardiac failure, emesis, delirium, coma, and death Most cases of Graves disease are associated with a diffuse firm goiter What is this?

Exercise Induced Asthma

Signs/Symptoms: Confusion Sweating Drowsiness FEV1 of less than 40%, Low level of oxygen saturation Use of accessory muscles for breathing Wheezing Cyanosis Coughing Hypotension Bradycardia or tachycardia Mental status changes Loss of consciousness Inability to lie supine Inability to speak coherently Agitation Peak expiratory flow rates of less than 80% of the personal best or daily variability greater than 20% of the morning value indicate lack of control What is this?

Anticonvulsants

Small head circumference Anteverted nares Cleft lip and palate (occasionally) Distal digital hypoplasia Risks for spina bifida are increased What meds are associated with this?

Hospital discharge

Some women and their babies certainly can have early WHAT if follow up care is in place. A physician or healthcare provider should do another complete physical exam before the infant goes home True contraindications to early WHAT (<48hrs) include: - infant jaundice at 24 hours of life or less - known exposure to substances of abuse - physical or oral defects - maternal group B strep - poor feeding, or >10% weight loss in 24 hours Prior to leaving the hospital, certain evaluations are mandatory in the United States. They include: - Newborn screening, previously discussed is completed. Some states require this to be repeated at or before 2 weeks of age. - Newborn hearing screening - Car Seat Challenge. Some hospitals will provide a car seat to those unable to purchase one. Most hospitals will help parents install the seat correctly. (can look at www.safecar.gov ) - the first dose of Hepatitis B vaccine is administered unless contraindicated. - newborn care class, including how to bathe, care for umbilical cord and circumcision if performed - bilirubin check if indicated

P2

Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, appearing chiefly along the labia. This stage is difficult to see on photographs and is subtle What Tanner stage is this in girls?

P2

Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, appearing chiefly at the base of the penis. This is subtle What Tanner stage is this in boys?

AS

Squatting (incr preload-venous return) and afterload (SVR, if prolonged) What murmur increases?

HCM MVP

Squatting (incr preload-venous return) and afterload (SVR, if prolonged) What murmurs decrease?

Growth Charts

Standardized measurements Determine if children are growing 'appropriately.' Considers length, weight, Head circumference, age, and sex www.cdc.gov/growthcharts Best indicator of nutritional status What is this for?

AS

Standing (decr preload and afterload) What murmur decreases?

HCM

Standing (decr preload and afterload) What murmur increases?

Reading

Start when they are babies Aim for 20 minutes or more a day THIS helps with Parent Bonding Vocabulary Communication longer attention span listening skills and imagination Thinking skills

Barotrauma

Status Asthmaticus: It is important to avoid intubation and mechanical ventilation in status asthmaticus because of the substantial risk of WHAT WHAT and hemodynamic compromise from dynamic hyperinflation and the generation of high autoPEEP are serious concerns in the mechanically ventilated asthmatic The use of PEEP is contraindicated in asthma, because PEEP presents further hinderance to expiration and could worsen dynamic hyperinflation If endotracheal intubation is necessary, an overall strategy is to provide adequate ventilation to maintain an arterial pH of at least 7.20, without concern for the Paco2 level per se, unless contraindications to hypercapnia exist Extreme hemodynamic instability and elevated intracranial pressure

Caustic Agents

Strong acids are commonly found in metal and toilet bowl cleaners and batteries Clinical Findings: Painful swallowing Mucous membrane burns Bloody emesis Abdominal pain Respiratory distress due to edema of the epiglottis Thirst Shock Renal failure Coma and convulsions are rare, but sometimes are seen terminally Residual lesions include esophageal, gastric, and pyloric strictures as well as scars of the cornea, skin, and oropharynx Emetics and NG lavage are contraindicated What is this?

A

Studies in pregnant women have not shown an increased risk for fetal abnormalities if administered during the first (second, third, or all) trimester(s) of pregnancy, and the possibility of fetal harm appears remote Fewer than 1 percent of all medications are in this category Examples include levothyroxine, potassium supplementation, and prenatal vitamins, when taken at recommended doses What category is this with FDA system?

ALTE (Apparent life threatening event)

Sudden frightening event Usually includes some combination of: Obstructive or central apnea Color change Change in muscle tone (usually limp) Choking or Gagging Observers often fear that the child has died or would have died without immediate heroic intervention Potential causes of ALTE are numerous - Approximately 1/3 of causes are GI related Reflux Enteritis Esophageal dysfunction Surgical abdomen Dysphagia Other causes include Neurologic Idiopathic apnea of infancy Respiratory ENT Cardiac Metabolic Infectious Other What is this?

Vit D Fluoride Iron

Supplement what if low dietary intake or sunlight exposure No what before 2 years old & only a "pea-size" until age 6 Supplementwhat for preterm and weaning infants All formulas should contain this

Poisoning

Supportive care ABCs Gastric Decontamination with whole-bowel irrigation-charcoal and polyethylene bind together to eliminate the toxin Single-dose activated Charcoal Polyethylene Glycol (Go-Lytely) Enhanced elimination Multiple-dose activated charcoal Alkalinization of urine Dialysis-aspirin overdose Specific antidotes: Acetaminophen - N acetylcystine Benzodiazepines - lumazenil Beta blocking - Glucagon Carbon monoxide - O2 TCA - Sodium bicarbonate Iron - Deferoxamine Lead - Edetate calcium disodoim (EDTA) Nitrates - Methylene blue Opiates - Naloxone Organophosphates - Atropine What is this tx for?

Not innocent cardiac murmurs

Symptomatic Diastolic Holosystolic Late Systolic Continuous (except venous hum) Associated with a Thrill What are these?

Cardiac

Symptoms Chest pain Palpitations Dizziness Syncope Syncopal episode(s) in young athlete is a MAJOR red flag for a serious cardiac condition and requires referral to cardiology for full work up prior to clearance for athletic activity Physical Exam All diastolic murmurs require further work up Systolic murmur III/VI or greater Diagnostic Tests ECG- Normal ECG findings in endurance athletes Ventricular hypertrophy Primary AV block Nonspecific ST wave changes in the lateral leads on ECG Resting sinus bradycardia around 40 beats per minute Echocardiogram What eval is this with PPE?

Mild TBI (MTBI)/Concussion

Symptoms - may be immediate or delayed Headache or a feeling of pressure in the head Temporary loss of consciousness Confusion Amnesia surrounding the traumatic event Dizziness or "seeing stars" Ringing in the ears Nausea Vomiting Slurred speech Delayed response to questions Appearing dazed Fatigue Symptoms in non-verbal children: Appearing dazed Listlessness and tiring easily Irritability and crankiness Loss of balance and unsteady walking Crying excessively Change in eating or sleeping patterns Lack of interest in favorite toys What is this w/PPE?

Hyperparathyroidism

Symptoms: Bone/Joint/Muscle aches and pain with common fractures Kidney pain/stones Excess urination Abdominal pain Nausea/Vomiting/Diarrhea Fatigue Altered mental status Depression Headache What is this?

Mild Intermittent

Symptoms: <2 days/wk Nighttime awakenings: 0 Short-acting beta-agonist use for symptom control: <2 days/wk Interference with norm activity: None What classification of asthma severity is this with 0-4 years of age range?

Mild persistent

Symptoms: >2 days/wk but not daily Nighttime awakenings: 3-4x/month Short-acting beta agonist use for symptom control > 2 days/wk but not daily, and ot more than 1x on any day Intereference w/normal activity: Mior limitation FEV > 80% predicted FEV1/FVC normal What asthma classification is this over 5-11 and 12 years of age?

Mild persistent

Symptoms: >2 days/wk, but not daily Nighttime awakenings: 1-2X/month Short-acting beta-agonist use for symptom control: >2 days/wk but not daily Interference with norm activity: Minor What classification of asthma severity is this with 0-4 years of age range?

Heat Stroke

Symptoms: Confusion, dizziness, hallucination, headache, nausea, vomiting, syncope Signs: Core temp > 104⁰F (40⁰C), altered mental status, hot skin with or without perspiration, hypotension, seizure, tachycardia Tx: Initiate onsite cooling, IV hydration, transport for emergency care. What is this?

Moderate persistent

Symptoms: Daily Nighttime awakenings: >1x/wk but not nightly Short-acting beta agonist used: daily Interference with norm activity: some limitation FEV > 60% but <80% predicted, FEV1/FVC reduced 5% What asthma classification is this 5-11 and over 12 years of age?

Mild illness (Heat cramps, Heat exhaustion)

Symptoms: Diarrhea, dizziness headache, irritability, loss of coordination, nausea, vomiting, syncope, weakness Signs: Core temp <104⁰F (40⁰C), normal mentation, pallor, tachycardia, hypotension Tx: Move to cool location, hydration, rest, sodium ingestion What is this?

Mild intermittent

Symptoms: Less than 2 days/wk Nighttime awakenings: Less than 2x/month Short acting beta agonist use for symptom control: Less than 2 days/wk No interference with normal activity Norm FEV1 btw exacerbations FEV over 80% predicted FEV1/FVC norm What classification is this with asthma severity 5-11 and over 12 years of age?

Severe persistent

Symptoms: T/out the day Nighttime awakenings: >1x/wk Shor-acting beta-agonist use for symptom control: several times per day Interference with norm activity: Extremely limited What classification of asthma severity is this with 0-4 years of age range?

Severe persistent

Symptoms: T/out the day Nighttime awakenings: Often 7x/wk Short-acting beta agonist used: Several times per day Interference with norm activity: Extremely limited FEV1 < 60% predicted FEV1/FVC reduced >5% What asthma classification is this 5-11 and over 12 years of age?

Moderate persistent

Symptoms:daily Nighttime awakenings: 3-4x/month Short-acting beta-agonist use for symptom control: daily Interference with norm activity: Some limitation What classification of asthma severity is this with 0-4 years of age range?

Innocent Cardiac Murmurs

Systolic Ejection Murmurs No associated structural abnormality Loudest over Left Sternal Border Soft Intensity Medium pitch Crescendo - Decrescendo Remember Increased flow states can present with murmurs. Anemia Thyrotoxicosis Fever What is this?

CT MRI

THIS or THIS imaging findings of subdural hemorrhage in infants—in the absence of a clear accidental history—are highly correlated with abusive head trauma Any infant or very young child with suspected abuse-related head trauma should be evaluated immediately

Fetal Valproate Syndrome

Tail forehead Medial eyebrow deficiency Flat nasal bridge Broad nasal root Shallow philtrum Long upper lip Thin vermillion border What teratogen med is this?

Behavior Assessment System

Temperament clusters: Easy child: (positive mood, regular; adaptable, low intensity, positive to novelty) lowest risk of future emotional/behavior problems Difficult child: (Negative mood, irregular rhythm, slow to adapt, intense reactions and negative responses to novelty.) Slow-to-warm-up: (Negative response to novelty; mild intensity; gradual adaptation after repeated contact) highest risk of future emotional/behavior problems (70%) What assessment screening tool is this?

Abdomen Umbilical cord Bladder

The WHAT in a newborn is round and full, and bowel sounds should be present when the infant is just a few minutes old. The liver can be felt easily about 1-2 cm below the costal margin, and the kidneys can also be palpated. The spleen is not normally palpated in the newborn. The WHAT will have a clamp in place, and the vessels will be clearly visible for the first few hours. The cord will be observed for any bleeding and signs of infection by the nursery team. The WHAT may be palpated just below the umbilicus. A firm, distended bladder requires further investigation.

Asthma

The airway mucosa is infiltrated with activated eosinophils and T lymphocytes, and there is activation of mucosal mast cells Structural changes of the airways: Thickening of the basement membrane due to subepithelial collagen deposition The epithelium is often shed or friable, with reduced attachments to the airway wall and increased numbers of epithelial cells in the lumen The airway wall itself may be thickened and edematous Another common finding is occlusion of the airway lumen by a mucous plug There is vasodilation and angiogenesis The airways may be narrowed, erythematous, and edematous What pathophys airway remodeling is this?

Theophylline

The bronchodilator effect is due to inhibition of phosphodiesterases in airway smooth-muscle cells, which increases cyclic AMP, but doses required for bronchodilatation commonly cause side effects Theophylline does have an additional anti-inflammatory effect and may, therefore, reduce corticosteroid insensitivity in severe asthma. Clinical Use: Oral theophylline is usually given as a slow-release preparation once or twice Low doses of theophylline have additive effects to ICS and are particularly useful in patients with severe asthma Side effects: The most common side effects are nausea, vomiting, and headaches and are due to phosphodiesterase inhibition Diuresis and palpitations may also occur, and at high concentrations, cardiac arrhythmias, epileptic seizures, and death may occur What tx is this with asthma?

Cyanotic Heart Disease

The classic and most commonly encountered lesion in adults and during pregnancy is the Tetralogy of Fallot Characterized by: Large ventricular septal defect Pulmonary stenosis Right ventricular hypertrophy An overriding aorta that receives blood from both the right and left ventricles Women with WHAT generally do poorly during pregnancy Cyanotic congenital heart disease 4-34% MI/stroke/death 12-40% miscarriage Fetal complications related to maternal cardiac disease include increased risk of: Miscarriage Stillbirth Intrauterine growth restriction and prematurity Iatrogenic preterm birth for maternal indications Fetuses of women with congenital heart disease are also at increased risk of congenital heart defect

Lung development

The embryonic or bronchial bud stage - from conception to about 56 days of gestation -The pseudo-glandular stage - from 6 to 16 weeks of gestation -The canalicular stage - from 16 to 26 weeks -Terminal sac phase - from 27 to 40? weeks -Alveolar period - from 32 weeks of gestation to 8 years of age This is an overview of what?

Breast

The examiner notes the size of the areola and the presence or absence of stippling (created by the developing papillae of Montgomery). The examiner then palpates the breast tissue beneath the skin by holding it between thumb and forefinger, estimating its diameter in millimeters. What is this w/ballard scoring with PE?

10 11

The fetal thyroid synthesizes thyroid hormone as early as the WHAT week of gestation Thyroid hormone appears in the fetal serum by the WHAT week of gestation and progressively increases throughout gestation The fetal pituitary-thyroid axis functions largely independently of the maternal pituitary-thyroid axis because maternal TSH cannot cross the placenta The thyroid-dependent brain maturation occurs at age two to three years after birth

Puberty

The first sign of normal THIS in boys is usually an increase in the size of the testes to more than 2.5 cm in the longest diameter Pubic hair development (Adrenarche) is brought about by adrenal and testicular androgen secretion and is classified separately from genital development Axillary hair develops in about a year after adrenarche Voice change, facial hair, and acne Early stage events in puberty Growth spurt occurs from 10.5 years to 16 years of age Late event

Cerebral Palsy

The history should include, in all ages evaluated, - Prenatal history - Perinatal history - Developmental history - History of motor dysfunction - Equipment history - General medical and surgical history PE: The findings on physical examination are variable Predominantly: Spasticity Hyperreflexia Ataxia-Involuntary movements Microcephaly In patients with hemiplegia, the affected arm and leg may be smaller and shorter than the unaffected limbsPhysical examination should always include a full neurologic evaluation Important findings to document include: Observation of posture, gait, truncal tone, and coordination Assess the degree of spasticity Check for primitive reflexes Evaluate and document range of motion for all limbs What is this for?

Neonatal Infections

The incidence of early-onset (< 3 days) neonatal bacterial infection is 1-2 in 1000 live births If rupture of the membranes occurs more than 24 hours prior to delivery, the infection rate increases to 1 in 100 live births Preterm births have an infection rate 5 times that of full-term infants Early-onset bacterial infections appear most commonly on day 1 of life, the majority by 12 hours of age Respiratory distress due to pneumonia is the most common presenting sign Late-onset bacterial infection (> 3 days of age) presents in a more subtle manner, with poor feeding, lethargy, hypotonia, temperature instability, altered perfusion, new or increased oxygen requirement, and apnea Late-onset bacterial sepsis is more often associated with meningitis or other localized infections. What is this?

Multiple Gestations

The incidence of twin gestation increases with maternal age Neonatal outcome is very much dependent on gestational age at delivery In general, morbidity and mortality rates are similar for twins and singletons of equivalent gestational Common complications for preterm twins include: Polyhydramnios IUGR Abnormal Presentation Congenital anomalies Intrauterine fetal demise Twin-to-twin transfusion syndrome Recent studies have found that neonatal morbidity is reduced when delivery is at about 38 weeks What is this?

Heel to ear

The infant is placed supine and the flexed lower extremity is brought to rest on the mattress alongside the infant's trunk. The examiner supports the infant's thigh laterally alongside the body with the palm of one hand. The other hand is used to grasp the infant's foot at the sides and to pull it toward the ipsilateral ear. The examiner fells for resistance to extension of the posterior pelvic girdle flexors and notes the location of the heel where significant resistance is appreciated. What is this w/ballard scoring?

Traction response

The infant is pulled by the arms to a sitting position. Initially, the head lags, then with active flexion, comes to the midline briefly before falling forward. What neuro exam is this?

Hypoparathyroidism

The major goals of monitoring in vitamin D deficiency are to ensure -get in gut or bone Maintenance of serum calcium and phosphorus concentrations within normal ranges Normalization of alkaline phosphatase activity for age Regression of skeletal changes Maintenance of an age-appropriate urine calcium-creatinine ratio The ratio should be less than 0.8 in newborns, 0.3-0.6 in children, and less than 0.25 in adolescents What is this monitoring for?

Midgut Malrotation

The midgut extends from the duodenojejunal junction to the mid-transverse colon During gestation, the midgut elongates into the umbilical sac, returning to an intra-abdominal position during the 10th week of gestation When rotation is incomplete, the dorsal fixation of the mesentery is defective and shortened, so that the bowel from the ligament of Treitz to the mid-transverse colon may rotate around its narrow mesenteric root and occlude the SMA and/or cause intestinal obstruction Malrotation leads to volvulus and accounts for 10% of neonatal intestinal obstructions What is this in children?

Perinatal mortality

The most common causes of what are: Unexplained intrauterine death in pregnancy Intrauterine death due to maternal complications Intrapartum death due to obstetric complications Inadequate management of birth Birth asphyxia Preterm birth Sepsis Congenital anomalies Low birth weight

Papillary Thyroid Carcinoma

The most common thyroid cancer is WHAT Carcinoma arising from the thyroid follicular cell Presentation: Present with local metastases to the cervical lymph nodes and occasionally with pulmonary metastases Treatment: Total thyroidectomy and removal of all involved lymph nodes, usually followed by radioiodine ablation Thyroid hormone replacement is started to suppress TSH secretion and stimulation of residual thyroid tissue and to treat the hypothyroidism Prognosis: Despite its aggressive presentation, children with THIS have a relatively good prognosis, with a 20-year survival rate greater than 90%

Sucking reflex

The newborn sucks in response to a nipple in the mouth; observed by 14 weeks' gestation. What neuro exam is this?

Newborn errors of metabolism

The number of recognized inborn errors has increased and are now recognized to affect 1:1500 children The pathology in metabolic disorders usually results from accumulation of enzyme substrate behind a metabolic block or deficiency of a reaction product The accumulated enzyme substrate is diffusible and has adverse effects on distant organs The substrate primarily accumulates locally Inborn errors can manifest at any time, can affect any organ system, and can mimic many common pediatric problems What is this?

Ages and Stages Questionnaire

The parent completes a 10 minute questionnaire Ex. "Can your baby pick up a Cheerio?" You score the questionnaire in under 5 minutes The cutoff points on the score sheet will give guidance. Discuss results with parents and determine a plan Suggest resources for follow-up, monitoring, learning activities, or further assessment if needed. What assessment screening tool is this?

confidentiality

The physician should address the issue of WHAT telling the parents that two meetings—one with the teenager alone and one with only the parents—will take place At the beginning of the interview with the patient, it is useful to say: "I am likely to ask you some personal questions. This is not because I am trying to pry into your personal affairs, but because these questions may be important to your health. I want to assure you that what we talk about is confidential, just between the two of us. If there is something I feel we should discuss with your parents, I will ask your permission first unless I feel it is life-threatening."

Newborn examination

The purpose of the WHAT is to identify abnormalities or anomalies that might impact the infant's well-being, and to evaluate for any acute illness or difficulty in the transition from intrauterine to extrauterine life Start with observation, then auscultation of the chest, and then palpation of the abdomen. Examination of the eyes, ears, throat, and hips should be performed last, as these maneuvers are most disturbing to the infant

Roseola Infantum (HHV-6 or HHV-7)

The rash begins on the trunk and spreads to the face, neck, and extremities Rose-pink macules or maculopapules, 2-3 mm in diameter, are non-pruritic, tend to coalesce, and disappear in 1-2 days without pigmentation or desquamation Very high fever 105

Ballard Score

The revised WHAT for estimating gestational age. It is also known as the Dubowitz score, for its inventor. It is fairly accurate Posture, scarf sign, plantar surface, square window, heel to ear, ear tissue, popliteal angle, lanugo, genitalia, arm recoil

Hep B and C

The risk of fetal infection is higher if maternal infection occurs in the third trimester Neonate infection can occur with breastfeeding Infants receive Hepatitis vaccine, with initial dose occurring at 2 days and 2 months of delivery *For infants of mothers HBsAG positive, give both vaccine and HBIG within 12 hours of birth* Screening available for pregnant women in high risk group There are no preventive measures known to reduce the risk of mother-to-child transmission Breastfeeding is appropriate in this group Ig does not contain antibodies to HCV and has no role in post-exposure prophylaxis What maternal infection is this?

G2

The scrotum and testes have enlarged, and there is a change in the texture and some reddening of the scrotal skin. There is no enlargement of the penis What Tanner stage is this in boys?

Alkali

The skin and mucous membranes should be cleansed with copious amounts of water Push oral fluids to dilute Routine esophagoscopy is no longer indicated to rule out burns of the esophagus due to chlorinated bleaches unless an unusually large amount has been ingested or the patient is symptomatic Antibiotics may be needed if mediastinitis is likely, but they should not be used prophylactically What tx is this for?

Chest radiograph Arterial blood gas

There are no recommended studies for this disease, however, a WHAT AND WHAT may be very important for the correct diagnosis. This is a non infectious process This is a non CO2 trapping disease, so non-acidotic pathology. Monitoring oxygenation by a non-invasive method will allow for the correct level of oxygen support. What is this with TTN-transient tachypnea of newborn?

B19

This benign exanthematous illness of school-aged children is caused by the human parvovirus designated THIS Spread is respiratory, occurring in winter-spring epidemics A nonspecific mild flulike illness may occur during the viremia at 7-10 days; the characteristic rash occurring at 10-17 days represents an immune response The patient is viremic and contagious prior to—but not after—the onset of rash

Oligohydramnios

This is an abnormally decreased amount of amnionic fluid *Amniotic ultrasound fluid index (AFI) < 2 cm* WHAT complicates approximately 1 to 2 percent of pregnancies Associated with *IUGR and major congenital anomalies, particularly of the fetal kidneys* *Uterine compression in the absence of amniotic fluid retards lung growth, and patients die of respiratory failure* The prognosis depends heavily on the underlying etiology and is variable

Plantar Surface

This item pertains to the major foot creases on the sole of the foot. The first appearance of a crease appears on the anterior sole at the ball of the foot. this may be related to foot flexion in utero. What is this w/ballard scoring with PE?

D

This medication can cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be apprised of the potential hazard to the fetus. This category also contains medications used to treat potentially life-threatening medical conditions Examples: corticosteroids, azathioprine, carbamazepine, and lithium What category is this with the FDA system?

X

This medication is contraindicated in women who are or may become pregnant. It may cause fetal harm. If this drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be apprised of the potential hazard to the fetus. There are a few medications in this category that have never been shown to cause fetal harm but should be avoided nonetheless Examples: Methotrexate, Warfarin, atorvastatin What category is this with FDA system?

Respiratory distress syndrome

This results from immature lungs that are unable to sustain necessary oxygenation Resulting hypoxia is an underlying associated cause of neurological damage such as cerebral palsy Hyperoxia, a side effect of RDS treatment, causes bronchopulmonary dysplasia and retinopathy of prematurity What is this associated with preterm labor and is a pivotal complication?

APGAR

This scoring system is the standard for estimating respiratory and neuro depression at birth. Scores are determined at precisely 1 min and 5 min after birth: they denote a baby who is healthy (7-10), mildly to moderately asphyxiated (4-6), and seriously at (0-3). A score of 10 is rare and a very low score at 5 min is more likely to predict residual neuro damage-although most infants with low 5-min scores survive and are normal. For a mnemonic aid to the categories, use appearance, pulse, grimace, activity, respiration. Color 0 Blue, pale; 1 Body pink, extremities blue; 2 Completely pink Heart rate 0 Absent, 1 <100, 2 >100 Response to nose catheter 0 No response; 1 Grimace; 2 Sneeze, cough Respiratory effort 0 Absent, 1 Slow, irreg; 2 Good, crying Muscle tone 0 Limp; 1 Some flexion of extremities; 2 Active motion What scoring is this?

The Interview

This time is associated with a shift in information gathering from parent to the adolescent The physical surroundings of the office and waiting room should make the adolescent feel comfortable and welcome (e.g., having adolescent-targeted information and magazines) Conversations about sports, movies, friends, and activities outside school can be useful to develop a rapport with patients HEADDSS Topics (Home/friends Education/employment Alcohol/Drugs Diet Sex Suicide/Depression) What is this?

Cardiac Murmurs

Timing and Duration Systolic Ejection or Holosystolic Diastolic Abnormal Continuous Abnormal or Venous Hum Location Intensity or Grade I to VI / VI Radiation-listen on back and clavicle and carotid-does it radiate anywhere else Frequency High (diaphragm) Low (bell) What is this for?

Posture

To elicit the item, the infant is placed supine (if found prone) and the examiner waits until the infant settles into a relaxed or preferred posture. If the infant is found supine, gentle manipulation (flex if extended; extend if flexed) of the extremities will allow the infant to seek the baseline position of comfort. What is this associated with the ballard scoring?

Sexual Abuse

To maintain a sense of comfort and routine for the patient, the genital examination should be conducted in the context of a full body checkup The majority of victims of THIS exhibit no physical findings Delay in disclosure by the child, abuse that may not cause physical trauma (e.g., fondling, oral-genital contact, or exploitation by pornographic photography) Rapid healing of minor injuries such as labial, hymenal, or anal abrasions, contusions, or lacerations Nonspecific abnormalities of the genital and rectal regions such as erythema, rashes, and irritation may not suggest THIS in the absence of a corroborating history, disclosure, or behavioral changes What PE is this for?

Augmentin (amox/clav) (90mg/kg /2 Alternate antibiotics include: cefuroxime axetil, cedpodoxime, clarithromycin and azithromycin Failure to respond to therapy - refer to ENT)

Treat sinusitis in children with antibiotic if there is severe symptom (Fever, pain radiating into teeth, facial swelling) present or if symptoms have lasted longer than 10 days What abx used?

Forearm

Treatment Both Bones - Fractures which are angulated more than 15-20 degrees and all Monteggia fractures require closed reduction and immobilization. Usually long arm cast for 6 weeks Non-displaced fractures in the proximal and middle third require long arm casts Non-displaced distal fractures - short arm cast What fracture tx is this for?

Slipped Capital Femoral Epiphysis (SCFE)

Treatment Goal = prevent further slippage of femoral head, promote closure of physis and avoid osteonecrosis. Most are treated with stabilization Severe deformities require emergent reduction and stabilization What tx is this for?

Legg-Calve-Perthes Disease (LCPD)

Treatment Goal = to maintain shape of femoral head Treatment is aimed at keeping femoral head located in acetabulum while remodeling occurs Observation is acceptable in children who are unlikely to develop deformity: Children younger than age 6 who do not exhibit significant subluxation Older children who have no involvement of the lateral portion of femoral head Abduction bracing - attempt to contain the femoral head within acetabulum, to maintain spherical femoral head Brace is worn all day and discontinued when lateral portion of femoral head regenerates. Usually 12-18 months. Osteotomy is reserved for older children with severe deformity What tx is this for?

Osgood-Schlatter Disease

Treatment Ice & NSAIDS before/after sports Patellar strap Kinesio taping during competition Decreased activity in acute episodes of severe symptoms Immobilization may be required for severe symptoms Rarely surgery may be required. Only in patients with persistent symptoms after growth has stopped. Excision of heterotopic ossification and prominence of tibial tuberosity What is this tx for?

Hypothyroid

Treatment Levothyroxine (75-100 mcg/m2/d) is the drug of choice for acquired In neonates with congenital, the initial dose is 10-15 mcg/kg/d Serum total T4 or FT4 concentrations are used to monitor the adequacy of initial therapy because the normally high neonatal TSH may not normalize for several days to weeks Subsequently, T4 and TSH are used in combination, as elevations of serum TSH are sensitive early indicators of the need for increased medication or better compliance What tx is this for?

Clubfoot

Treatment Manipulation and casting Treatment needs to begin immediately, otherwise foot becomes stiff and non operative treatment is more resistant Serial casting is required for 2-4 months Ponsetti method What tx is this for?

Osteosarcoma

Treatment Medical therapy Neoadjuvant (preoperative) chemotherapy has been found to facilitate subsequent surgical removal by causing tumor shrinkage and to provide oncologists with risk parameters. Patients in whom there has been a good histopathologic response to neoadjuvant chemotherapy (>95% tumor cell kill or necrosis) have a better prognosis than those whose tumors do not respond Surgery are not particularly responsive to radiotherapy Surgery is the only option for definitive tumor removal Surgery The primary aim of surgical resection is patient survival Wide margin resection - margins on all sides of the tumor must contain normal tissue. Adequate margin is thought to be 5-7 cm from the edge of an abnormality depicted on magnetic resonance imaging (MRI) or bone scanning Radical margin resection - removal of the entire involved compartment (bone, joint to joint; muscle, origin to insertion). This is usually not required for cure. Amputation may be necessary in some cases Surgery Limb salvage surgery Autologous bone graft-own tissue Allograft-donor tissue Prosthesis Rotationplasty What is this tx for?

Calcaneovalgus Foot (Flatfoot)

Treatment Most flattening of the longitudional arch will improve with time Corrective shoes and orthotics have not shown to improve the development of the arch, but may improve symptoms Heel cord stretching may improve arch pain Surgery is rarely indicated Adult with cavus feet (high arches) are more likely to have foot pain than adults with flat foot What is this tx for?

Scoliosis

Treatment Most idiopathic curves never progress to require treatment Regular observation during adolescence is recommended Frequency of observation depends on severity of the curve Exercise therapy does not change curve progression Less than 20 degrees observation 20-45 degrees bracing Over 45 degrees surgery Treatment Observation intervals depend on degree of curve and amount of growth remaining For curves < 20⁰ repeat exam and x-rays every 3 months for children pre-menarche and every 6-12 months for those post-menarche For curves > 20⁰ brace and repeat exam and x-rays every 3 months for those pre-menarche. Post--menarche no brace is necessary but repeat exam every 3 months Surgery for curves > 50⁰ or curves 40⁰-50⁰ that are likely to progress Bracing for curves 20-45⁰ Goal is to arrest progression of the curve. Those with limited growth remaining (post-menarche) require no bracing What is this?

Clavicle Fracture

Treatment Newborns - no treatment Young Children - immobilize and observe. Usually in sling or figure 8 strap Adolescents - Sling or figure 8 strap unless fracture is tenting or blanching the skin. Severely displaced fractures may require surgery Immobilize for 4-6 weeks and then begin ROM. Physical therapy is rarely needed This tx is for what?

Supracondylar Humerus

Treatment Non-displaced fractures may be treated with splint or cast immobilization for 4-6 weeks. Repeat x-rays weekly for first 2-3 weeks to assess alignment Displaced fractures require reduction and in most cases pinning Supracondylar humerus fractures have a high rate of neurovascular problems Failure to recognize vascular injury may result in Volkmann ischemic contracture Malunion may result in loss of carrying angle What fracture is this tx for?

Exercise Induced Asthma (Return to play after an attack: No specific guidelines describe RTP after an asthma attack in an athlete The athlete should first be asymptomatic Progress athlete through graded increases in exercise activity Lung function should be monitored with a peak flow meter and compared with baseline measures to determine when asthma is sufficiently controlled to allow the athlete to resume)

Treatment Recognize and avoid triggers Medication: Short-acting β2-agonist should be readily available Onset of action is typically 5 to 15 minutes Up to 3 treatments per hour Refer to ER or urgent care if: Breathing difficulties continue after 3 treatments in 1 hour Athlete continues to have any signs or symptoms of acute respiratory distress Provide supplemental oxygen to help maintain blood oxygen saturation above 92% What is this tx for?

In-Toeing

Treatment Shoe modifications, braces, and exercise do not alter developmental changes in femoral or tibial torsion Casting is occasionally necessary to correct foot deformity such as metatarsus adductus Most children grow out of in-toeing without treatment In rare cases consistent tripping or unsightly gait may require surgical correction, if not improved by age 7 or 8 What tx is this for?

Osteomyelitis

Treatment Start IV antibiotics immediately after obtaining diagnostic tests and cultures Surgery to drain sub-periosteal abscess is indicated when symptoms and fever continue despite antibiotic therapy In chronic cases, surgery may be needed to resect or debride necrotic or avascular tissue Antibiotics should continue for at least 6 WEEKS, depending on clinical response Typical organisms include Staph aureus, Group B strep, or Haemophilus influenza Consider Pseudomonas if infection is related to a nail puncture wound What tx is this for?

Cerebral Palsy

Treatment and management are directed at assisting the child to attain maximal neurological functioning with appropriate physical, occupational, and speech therapy Orthopedic monitoring and intervention and special educational assistance may all contribute to an improved outcome Treatment of spasticity (with dantrolene, benzodiazepines, baclofen, or botulinum toxin) and seizures are needed in many children Also important is the general support of the parents and family with counseling, educational programs, and support groups No cure currently What tx is this for?

Rotavirus

Treatment is nonspecific and supportive, aimed at replacement of fluid and electrolyte deficits, along with ongoing losses, especially in small infants The use of oral rehydration solutions is appropriate in most cases The use of clear liquids or hypocaloric (dilute formula) diets for more than 48 hours is not advisable Early initiation of refeeding is recommended What is this for?

Hirschsprung disease

Treatment is surgical At the time of definitive surgery, the transition zone between ganglionated and nonganglionated bowel is identified Aganglionic bowel is resected, and a pull-through of ganglionated bowel to the preanal rectal remnant is made In children with ultrashort segment disease, an internal anal sphincter myotomy, or botulinum toxin injection of the internal anal sphincter may control symptoms. Complications after surgery include: Fecal retention Fecal incontinence Anastomotic breakdown Anastomotic stricture Postoperative obstruction may result from inadvertent retention of a distal aganglionic colon segment Enterocolitis occurs postoperatively in 15% of patients What is this for?

Congenital Pneumonia

Treatment of inflammation is as important as antimicrobial therapy. Antimicrobial therapy should be carefully chosen to assure adequate plasma concentration as well as alveolar coverage. Respiratory support is usually necessary. Hemodynamic support may be necessary in cases of systemic infection. Nutritional support is very important. What tx is this for?

Tibial

Treatments Treatment focuses on reducing angular deformity and maintaining joint alignment Toddlers fractures, stress fractures and most non-displaced fractures can be managed with a cast or a boot Displaced shaft fractures require reduction and long leg casting Displaced intra-articular of physeal fractures need closed or open reduction with fixation or casting All open fractures require surgical irrigation and debridement What fracture tx is this for?

Tonic neck reflex

Turn the infant's head to one side; the arm and leg on that side will extend while the opposite arm and leg flex ("fencing position"). This reflex disappears by age 4 months. What neuro exam is this?

Functional Constipation

Typically, the child is not ill or toxic appearing The abdomen may be slightly distended with an increased girth, and occasionally hard stool can be felt in the left lower quadrant Inspect the anal vault for fissures and anatomic positioning A rectal examination is always recommended to assess presence of stool, rectal tone (tonic constriction of the sphincter with an empty rectal vault suggest Hirschsprung disease), sensation, and size of the anal vault Carefully palpate the abdomen for the presence of a mass, as abdominal or sacral tumors are a rare but important cause of pathologic constipation Check lower extremity tone, reflexes, and gait for signs of spasticity that may signal spinal cord abnormalities What is this PE for?

Monteggia

Ulna fracture with radial head dislocation What forearm fracture is this found in kids?

Transposition of great arteries

Uncontrolled diabetic mothers are the high risk group to produce THIS defect in their babies?

Fluid loss

Unlike adults, children tank quickly with WHAT? They have a higher metabolism and higher rate of fluid turnover Fluid loss estimates: Fever : 10% per degree Exercise: 5-20% Tachypnea: 10-20% Anuria:60%

Raw Milk

Unpasteurized milk CDC View THIS causes TB, brucellosis, or food poisoning....death? Historically and in present day, THIS is a natural product that has been and continues to be consumed safely around the world. Use common sense and evidence What is this?

Recurrent Otitis Media

Up to 20% of children > 3 in six months or >4 in 12 months Usually asymptomatic except possibly decreased hearing Eustachian tube dysfunction May require myringotomy tubes (also known as PE (pressure equalization)) tubes Prevention breastfeeding no bottle propping environment smoke free What is this?

Rotavirus

Use either RotaTeq or Rotarix to prevent gastroenteritis from THIS RotaTeq is given as a 3 dose series at 2, 4, and 6 months Rotarix is given as 2 dose series at 2 and 4 months For both vaccines; minimum age for dose 1 is 6 weeks, maximum age for dose 1 is 14 weeks and 6 days, minimum interval between doses is 4 weeks, no doses given after 8 months and 0 days of age Almost all unvaccinated children get rotavirus before the age of 5 and in developing countries, 500,000 die each year. CI: Severe hypersensitivity or allergy to component, previous serious allergic reaction, history of intussusception, Rotarix contains latex so avoid in severe latex allergy, severe combined immunodeficiency (SCID) Defer in patients with acute gastroenteritis Adverse effects: small increase in risk of intussusception What vaccine is this with children?

Diarrhea

Usually a result of diet High simple carb. diet Juice Low fat diet Soy or dairy in some Sugar substitutes What is this in kids?

Developmental Dysplasia of the Hip (DDH)

Usually associated with ligamentous laxity which is present at birth Clinical Symptoms Neonates are asymptomatic Parents notice a limp or waddling gait or leg length discrepancy. Usually noticed when child begins to walk Physical Examination PE is key to early diagnosis Barlow Test - "sign of exit", femoral head dislocates from socket Ortolani Test - "sign of relocation", femoral heal is manipulated back into socket Physical Examination In neonates with missed hip dislocation the adductors contract and the hip cannot be relocated by Ortolani sign. These patients will have limited hip abduction on the affected side. Look for asymmetry in abduction when hip and knee is flexed to 90 degrees Galaezzi Sign - unequal knee height with hips and knees flexed is a sign of hip dislocation What is this?

Equinus

Usually unilateral, also called "toe walking" Children tend to grow out of this What type of gait is this?

AS PS TR

Valsalva (decr preload-venous return) What murmurs will decrease?

MVP HCM

Valsalva (decr preload-venous return) What murmurs will increase?

Steroid-Sparing Therapies

Various immunomodulatory treatments have been used to reduce the requirement for OCS in patients with severe asthma who have serious side effects with this therapy Methotrexate, cyclosporin A, azathioprine, gold, and IV gamma globulin have all been used as steroid-sparing therapies None of these treatments has any long-term benefit, and each is associated with a relatively high risk of side effects What asthma tx is this?

Kawasaki Disease

Vasculitis with multisystem involvement and inflammation of small and medium arteries. Aneurysm Formation. Unknown etiology 6 per 100,000 kids younger than 5. Most common in Asian descent Peak between February and May Males>Females Leading cause of acquired heart disease What is this?

Lanugo

Very fine, downy hair called WHAT may also be present. Dry, peeling skin may be noted in post term infants. Evaluate any rashes, bruises, or Mongolian spots.

Sexual Abuse

Victims may present in a number of ways: Withdrawn Aggressive Angry Depressed "Hypersexualized behavior" No signs of abuse may be a single event, but is most commonly chronic Most perpetrators are adults or adolescents who are known to the child and who have real or perceived power over the child Most involve manipulation and coercion of the child and is typically a physically nonviolent assault The child should be interviewed with questions that are open-ended and non-leading In all cases, the child should be questioned about medical issues related to the abuse, such as timing of the assault and symptoms, such as bleeding, discharge, or genital pain What is this presentation and hx for?

Pediatric Fever

Vitals: Temperature Heart Rate Respiratory Rate BP Oxygen saturation Complete physical examination including neuro exam What PE is this for?

Neisseria gonorrhoeae infection or syphilis

WHAT beyond the perinatal period is diagnostic of sexual abuse Chlamydia trachomatis, herpes simplex virus, trichomoniasis, and human papillomavirus are all sexually transmitted, although the course of these potentially perinatally acquired infections may be protracted Herpes simplex can be transmitted by other means The presence of an infection should prompt a careful assessment for sexual abuse Risk is higher in children older than five with isolated genital lesions or with herpes simplex type 2 infections In the case of human papillomavirus, an initial appearance of venereal warts beyond the toddler age should prompt a discussion regarding concerns of sexual abuse Sexual abuse must be considered with the diagnosis of Chlamydia trachomatis or human immunodeficiency virus (HIV) infections when other modes of transmission (e.g., transfusion or perinatal acquisition) have been ruled out

Emotional or psychological abuse

WHAT has been defined as: Rejection Ignoring Criticizing Isolation Terrorizing All of these have the effect of eroding self-esteem The most common form is verbal abuse or denigration The most common feature of emotional neglect is the absence of normal parent-child attachment and a subsequent inability to recognize and respond to an infant's or child's needs A common manifestation of emotional neglect in infancy is nutritional (nonorganic) failure to thrive

Supplemental Oxygen

WHAT is always warranted in the trauma patient but is particularly critical in the injured pregnant patient, because the oxygen dissociation curve is shifted to the left for the fetus compared to the mother

Axial loading

WHAT is the major mechanism of serious cervical injuries More dangerous when head is slightly flexed: The spine is brought out of its normal lordotic alignment, which does not allow for distribution of the force to the thorax The musculature cannot assist in absorbing the force. Injury occurs to the cervical spine when it is compressed between the body and the rapidly decelerating head. Flexion injuries are the primary cause of cervical fracture, dislocation, and quadriplegia Extension injuries are less severe

UTI

WHAT is uncommon in the first days of life Occurs in association with genitourinary anomalies and is usually caused by gram-negative enteric pathogens, or enterococcus Evaluation for genitourinary anomalies with an ultrasound examination and a voiding cystourethrogram should be done in most cases.

Infant mortality

WHAT refers to all deaths of children younger than 1 year of age The sum of neonatal and postneonatal mortality

Mal-presentation

WHAT refers to any position of the fetus in which the vertex is not the body part presenting at delivery. Operative deliveries must meet certain criteria, before being performed. These deliveries include forceps deliveries, and vacuum extraction procedures.

Neonatal mortality

WHAT refers to death from birth to 28 days of age?

Perinatal deaths

WHAT refers to fetal deaths occurring from the 20th week of gestation until the 7th day after birth

CRAFFT acronym

WHAT refers to the questions, which refer to substance abuse in the context of: Riding in a Car Trying to Relax Using while Alone Forgetting about things done while under the influence Receiving feedback from Family or Friends about substance abuse Getting into Trouble while under the influence

GERD

Warning signs that warrant further investigation in the infant with recurrent vomiting include: Bilious emesis GI bleeding Onset of vomiting after 6 months Failure to thrive Diarrhea Fever Hepatosplenomegaly Abdominal tenderness or distension Esophagoscopy and mucosal biopsies are useful to evaluate for mucosal injury secondary to THIS (Barrett esophagus, stricture, erosive esophagitis Endoscopic evaluation is not required for the evaluation of all infants and children with suspected THIS Intraluminal esophageal pH monitoring (pH probe) and combined multiple intraluminal impedance and pH monitoring (pH impedance probe) are indicated to quantify reflux

Acid Injuries

Water or milk (< 15 mL/kg) is used to dilute the acid, because a heat-producing chemical reaction does not occur Take care not to induce emesis by excessive fluid administration Alkalis should not be used Burned areas of the skin, mucous membranes, or eyes should be washed with copious amounts of warm water Opioids for pain may be needed An endotracheal tube may be required to alleviate laryngeal edema Esophagoscopy should be performed if the patient has significant burns or difficulty in swallowing, drooling, vomiting or stridor What is this tx for?

Hypocalcemia

Weakness *Muscle cramps/twitching* Tingling: Mouth Fingers/toes Anxiety Thin, brittle nails Dry, scaly skin Anxiety Seizures These are symptoms of what?

Bike Helmet/Safety

Wear a helmet at ALL times when bicycling, skating, ETC. Make sure the helmet fits properly Teach kids bike safety: Ride on the right side of the road, with traffic, not against it. Use appropriate hand signals Make sure drivers are paying attention and are going to stop before you go What anticipatory guidance is this?

Appropriate for Gestational Age (AGA)

Weight between 10th and 90th percentile An appropriate for gestational age full-term infant is heavier than 2,500 grams (about 5.5 lbs.) and lighter than 4,000 grams (about 8.75 lbs.) An WHAT baby tends to have the lowest risk for any problems WHAT babies have lower rates of disease and death than babies that are small or large for their gestational age

24 hours

Well-appearing infants ages 29 to 90 days who are sent home must have follow up within WHAT either by phone or by visit, at which time preliminary culture results (if obtained) are reviewed Patients who received parenteral antibiotics at the initial visit should return for a second intramuscular dose (e.g., ceftriaxone 50 mg/kg) pending final culture results. Any of the following circumstances warrants extensive evaluation and hospitalization for empiric antibiotic therapy with cefotaxime, ceftriaxone, or other antibiotics, as indicated: Any deterioration in clinical status or worsening of fever A positive blood culture not thought to be a contaminant A positive urine culture in an infant who remains febrile For an infant with a positive urine culture who is afebrile and well-appearing less than 24 hours after parenteral ceftriaxone, it may be reasonable to give a second dose of parenteral ceftriaxone at 24 hours and continue outpatient follow-up

Colic

Wessel's "Rule of Threes": Crying more than 3 hours per day for more than 3 days per week for more than 3 weeks. The crying of THIS - paroxysmal, facial grimacing, drawing up of the legs and passing flatus. Etiology - unknown Occurs in 5 to 19 % of children Must differentiate from rare organic diseases or other causes with good history and PE.

0.9% NaCl Normal Saline (Contains 900mg or 0.9g of sodium chloride per 100mL) (1/2 normal saline or 0.45% saline elicits hyponatremia in small children)

What IV fluid is chosen for children 10-over 20 kg?

Ondansetron (zofran) (Avoid using Dopamine receptor agonists Promethazine Procholrperazine Metaclopramide Droperidol Potential for serious side effects, including respiratory depression and extrapyramidal reactions Also lack efficacy Antidiarrheal medications are not recommended-stop colon from getting infection out)

What antiemetics are used in children with acute gastroenteritis?

Polio Influenza

What are 2 inactivated vaccines that have produced by killing the dz causing microbe with chemicals, heat, or radiation and is more stable and safer than live vaccines and require boosters?

MMR Varicella (chicken pox)

What are 2 live, attenuated vaccines that contain a version of the living microbe that has been weakened?

Arterial blood gas values

What are done to determine the amount of hypoxia. Respiratory acidosis occurs because of alveolar atelectasis and/or over-distension of terminal alveoli. Metabolic acidosis is primarily a lactic acidosis from poor tissue perfusion. Hypoxia results in a right-to-left shunt through the foramen ovale and patent ductus arteriosus. All related to respiratory distress syndrome

Ortolani and Barlow

What are the 2 tests that test for hip dislocation in newborns?

APGAR score Quick Physical Exam Gestational age estimate (A full-term newborn is a baby born at 37 weeks' or more gestation Term newborns are evaluated in the delivery room immediately after birth to assure that they do not require respiratory or circulatory support, have no birth-related trauma or congenital anomalies requiring immediate intervention, and are transitioning as expected to extrauterine life Approximately 97% of newborns are healthy and require only routine care in the nursery after birth APGAR Scoring)

What are the 3 assessments for delivery of infant?

Unintentional injury (Motor-vehicle collisions Poisonings - Including prescription drug overdose) Homicide/Assault (Firearms) Suicide (Firearms, suffocation) (The mortality rate of adolescent males aged 15-19 was more than twice that of females (69.6 vs 28.1 per 100,000, respectively), largely due to higher rates of unintentional injury, homicide, and suicide death among males)

What are the 3 leading causes of death in adolescents?

First Stage 0-30 minutes the first period of reactivity - Second Stage 30 minutes to 2 hours a period of decreased responsiveness -Third Stage 2 to 8 hours the infant has a second period of reactivity.

What are the 3 stages of the transition period with a neonate in a nursery?

Spastic Ataxic Dyskinetic

What are the 3 types of cerebral palsy?

VSD, Pulmonary Stenosis, Overriding Aorta and Right Ventricular hypertrophy (Overriding Aorta = aorta shifted slightly to the right and lies directly above VSD. This allows blood from RV and LV mixing blood. )

What are the 4 structural lesions with tetralogy of fallot?

Ultrasound for fetal nuchal thickness PAPP-A (Pregnancy-Associated Plasma Protein -A) (Both of these tests look for Down Syndrome) HCG (Human Chorionic Gonadotropin) (Used to assess fetal wellbeing or demise)

What are the additional testing for advanced age in the first trimester?

Blood type antibody screen Triple Screen (AFP (alpha-fetoprotein) Neural tube defect Estriol Test of placental and fetal liver health HCG Test of fetal viability) Quad Screen (Inhibin-A for Down syndrome)

What are the additional testing for advanced age with second trimester?

S. pneumoniae, H. influenzae, Moraxella catarrhalis, S. aureus, other streptococci and anaerobes

What are the bacteria causing sinusitis?

S. pneumoniae, nontypable H. Influenzae, Moraxella catarrhalis, Group A strep

What are the bacterial pathogens for acute otitis media?

Urine Culture (essential for diagnosis in children Infants and small toddlers )suprapubic aspiration or catheterization (Bagging problematic: skin contamination) Renal sonogram, voiding cystourethrogram (VCUG) (Recurrent infections require prophylactic antibiotics Long term complications include renal scarring and hypertension)

What are the components of UTI eval?

Often is suspected clinically, but confirmatory tests include: Lung Function Tests: (FEV1, FEV1/FVC, PEF) Airway responsiveness (Methacholine or histamine challenge) Radioallergosorbent test (RAST) (Allergen testing) Exhaled nitric oxide challenge (Measures eosinophilic airway inflammation)

What are the dx labs of asthma?

CBC (Poor sensitivity and specificity Should not be used in decision making for more thorough evaluation) Blood Cultures (Does not help with immediate assessment Routinely obtained in infants <60 days of age) C Reactive Protein (Better indicator of toxicity in neonates than CBC) UA and Urine Culture (Must order culture with U/A Catheterized specimen) Cerebrospinal fluid (Studies are indicated for neonates with presence of fever and: Age ≤28 days Ill appearance Diagnostic evaluation identifies a high risk for bacterial infection Prior to administration of empiric antibiotics Clinically evident invasive infection (e.g., cellulitis, abscess, mastitis, omphalitis, osteomyelitis) Seizures Check fontenelles to see if bulging for assessing intracranial pressure) Chest radiograph (is helpful in identifying a source of infection in infants with at least one clinical sign of pulmonary disease Even when the chest radiograph reveals pneumonia, a viral etiology is most likely-RSV in children most common A bacterial process is more likely if alveolar disease (consolidation and air bronchograms) or bronchopneumonia (diffuse bilateral pattern with increased peribronchial markings and small fluffy infiltrates) is present)

What are the dx tests for neonatal fever?

A chest x-ray is essential. An arterial blood gas (measurement will determine the appropriate management.) Complete blood count (to aid in infection assessment.) Serum electrolytes (to assess kidney function which may be affected in perinatal stress.)

What are the lab studies for meconium aspiration syndrome?

(The most important tests involve the recovery of the responsible organism.) Blood cultures and cultures of respiratory secretions (are likely to yield the most information on the causative agent.) Complete blood counts (may be done, but do not stand alone in making a diagnosis.) (CSF??????) A standard well-done chest x-ray is one of the most helpful studies.

What are the lab studies with congenital pneumonia?

Fasting plasma glucose (at least 7.0 mmol/L) Hemoglobin A1c (At least 6.5%) Random plasma glucose (at least 11.1 mmol/L plus confirmation)

What are the measures of glycemia to dx gestational diabetes?

E. coli, Klebsiella, Proteus, Staph sapprophyticus

What are the pathogens for UTI in children?

Calculation by the mother estimated date of confinement (EDC) Collection of prenatal data: First fetal movement (16-20 wks) Fetal heart tones (20 wks w/doppler 9-12 wks) Fundal height (1 cm= 1 wk after 18-20 wks) 20 wks (fundus normally at umbilicus) Term (fundus at xyphoid) Amniotic fluid creatinine levels Maternal serum and urine estriols Fetal US

What are the prenatal gestational age assessment?

RSV Rhinovirus

What are the viral pathogens for acute otitis media?

Adenovirus (pharyngoconjunctival fever) Rhinovirus, parainfluenza virus, corona virus, RSV (respiratory syncytial virus) (Common cold viruses) EBV (Epstein-Barr virus) (Mononucleosis) Coxsackie virus (Ulcerative pharyngitis) Herpes simplex virus (Gingivostomatitis)

What are the viral pharyngitis etiologies?

Blood products

What can be important supportive therapies in patients with shock Platelets are generally transfused when platelet counts are less than 20,000/μL, or less than 40,000-60,000/μL in a patient with bleeding or requiring surgical intervention?

ECMO

What can be used as a life-saving measure in the treatment of severe shock in patients with recoverable cardiac and pulmonary function who have failed conventional management

Newborn skull

What consists of a group of partially calcified bony plates. Areas exists between these plates called sutures. The edges of these plates may override one another due to compression during the birth process.

Acute asthma exacerbation

What consists of progressively worsening wheezing, cough, shortness of breath, and/or chest tightness that is associated with decreased expiratory airflow

Replacement therapy

What corrects water and electrolyte deficits that have accrued via illness or physiologic abnormality. Returns the patient to a normal volume and electrolyte status. Requirements vary depending on the underlying clinical status?

Rheumatic heart disease

What develops after a group A β-hemolytic streptococcal infection of the upper airway Despite an overall decline in the incidence of rheumatic heart disease in Europe and North America, rheumatic valvular disease remains common in women of childbearing age The mitral valve is most commonly affected, followed by the aortic valve, and less frequently the tricuspid and pulmonic valves Mild rheumatic fever may be difficult to diagnose in pregnancy due to tachycardia, functional murmur, and anemia The risk of developing heart failure increases progressively throughout pregnancy and in the peripartum period. Labor imposes an additional load, and congestive failure may develop for the first time during labor

elevated serum transaminase and ammonia, prolonged PT, hypoglycemia, acidosis

What do the labs show for reye syndrome?

Fever and pneumonia

What have some abnormality on physical examination: usually tachypnea, abnormal auscultation, low pulse oximetry, retractions, or nasal flaring, suggesting respiratory tract disease A reliable physical examination in a young child can be a challenge Consider chest radiograph, as there is a correlation between infiltrate and leukocytosis In a pt 3-36 mons

36 weeks gestation

What includes a group B streptococcus screening test?

15-20 weeks gestation

What includes a maternal serum marker screening (alpha feto protein, others, depending on the risk factors). * "Triple Test" - low estriols, low sAFP, and elevated placental chorionic Gonadatropin levels?

First visit

What includes complete history and physical, blood type, hepatitis B surface antibody, rubella titer, HIV testing, Pap smear, sexually transmitted disease screening, hemoglobin, hematocrit and urinalysis?

Preterm

What infants were those delivered before 37 completed weeks Risk factors for spontaneous preterm labor include: Past history of spontaneous preterm delivery Premature rupture of the membranes Multiple gestation Black race Intrauterine infections Müllerian anomalies Smoking and substance abuse Bacterial vaginosis Certain socioeconomic conditions (such as limited access to prenatal care) Women with a shortened cervical length

C Reactive Protein

What is a better indicator of toxicity in neonates than CBC?

Asthma

What is a chronic inflammatory disorder of the airways Many cells and cellular elements play a role: Mast cells-release histamine-also recruit globlet cells Eosinophils T lymphocytes Macrophages Neutrophils Epithelial cells This inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning Associated with widespread but variable airflow obstruction that is often reversible The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli

Hib

What is a conjugate vaccine? (Some bacteria have an outer coating containing polysaccharides. This coating makes it difficult for an immature (child) immune system to recognize the antigen. Conjugate vaccines work to create a connection between the antigen in the vaccine to the polysaccharide coat so that the immune system can more easily identify the antigen and create an immune response.)

DTaP

What is a toxoid vaccine? (Some bacteria produce disease in the body by the toxins they produce. When a weakened toxin is introduced as a vaccine, the body develops immunity and is able to fight off the natural toxin if ever exposed.)

Acute severe asthma Status Asthmaticus

What is an episode associated with dyspnea at rest that interferes with conversation and that is associated with peak expiratory flow (PEF) of <40% of predicted value may progress to unresponsive airway obstruction, respiratory failure, and fatal asthma which leads to what?

PROM

What is an important cause of: Preterm labor Prolapse of the cord Placental abruption Intrauterine infection Chorioamnionitis is an important sequela of PROM and may precede endomyometritis or sepsis of the newborn In extremely prolonged rupture of the membranes, the fetus may have an appearance similar to that of Potter's syndrome (e.g., flattened facial features, wrinkling of the skin) If rupture of membranes with subsequent oligohydramnios occurs early in pregnancy at less than 26 weeks' EGA, it can cause pulmonary hypoplasia and limb positioning defects in the newborn?

Estimated gestational age

What is found first, then the height, weight, and head circumference are plotted on this chart. This determines if the child is appropriate for gestational age.

Rib notching

What is found on CXR with coarctation of the aorta?

Boot shaped heart

What is seen on CXR with tetralogy of fallot?

Egg on a string

What is seen on a CXR with transposition of great arteries?

Diffuse pattern of pneumonia Depressed diaphragm

What is seen on the radiograph with meconium aspiration syndrome?

Riding in a Car Trying to Relax Using while Alone Forgetting about things done while under the influence Receiving feedback from Family or Friends about substance abuse Getting into Trouble while under the influence

What is the CRAFFT acronym that refers to the questions which refer to substance abuse?

(Patients with severe asthma may present with signs that indicate severe airflow limitation and increased work of breathing, along with variable degrees of hypoxia These patients should be admitted to the intensive care unit for close observation and aggressive treatment) Supplemental oxygen Intravenous steroids High doses of inhaled β-agonists (usually initially by nebulization) Helium-oxygen mixtures (heliox) (in an 80:20 to 60:40 mix are used to reduce turbulent flow in the proximal airways) Noninvasive ventilation (may also reduce the work of breathing and buy time if the patient can tolerate the face mask) Intravenous aminophylline and oral antileukotriene agents (have also been used in the management of severe bronchospasm) Intravenous magnesium sulfate (may also be tried, but results from many trials fail to demonstrate consistent benefit)

What is the ICU tx of status asthmaticus?

Asthma Allergies Eczema

What is the atopic triad with asthma?

Ophthalmologic evaluations starting at 3-5 years after diagnosis and then annual Annual urine screening for mcroabluminuria Annual cholesterol measurements Periodic blood pressure evaluations

What is the checkup done on Type 1 DM in children?

Correct dehydration first Slow carbohydrate introduction (Rapid introduction can result in renal and cardiac failure Refeeding syndrome - "hypophasphotemai" increase CO2, decrease O2, arrhythmias, seizures.) NG tube assures accurate measurements Rehabilitation takes 6 weeks (The first week is very intense. Week 2-6 is aggressive nutritional intake: up to 200kcal/kg/day!)

What is the correction for malnutrition?

Beta Blockers

What is the drug of choice for Hypertrophic Cardiomyopathy in children?

Biopsy: (Ganglion cells are absent in both the submucosal and muscular layers of involved bowel Special stains may show nerve trunk hypertrophy and increased acetylcholinesterase activity Ganglionated bowel above the aganglionic segment is sometimes found to contain more than normal numbers of ganglion cells in abnormal locations) Barium enema (demonstrates: Narrow distal segment with a sharp transition to the proximal dilated (normal) colon Retention of barium for 24-48 hours is not diagnostic of Hirschsprung disease in older children as it typically occurs in retentive constipation as well) Rectal Manometry

What is the dx for Hirschsprung dz?

Labs often unhelpful WBC rarely higher than 15 Pyuria is often present Hemoccult positive stools sometimes seen Imaging: Ultrasound Abdominal CT

What is the dx for acute appendicitis in children?

Abdominal US (carries sensitivity for dx of intussusception of 98%-100%) Barium/air enema both dx and therapeutic (The constellation of abdominal pain, lethargy, vomiting, with a suspicious abdominal radiograph was found to have a sensitivity of 95% in identifying intussusceptions in children Abdominal radiographs alone are poorly sensitive for the diagnosis of intussusception) (Reduction of the intussusception by barium enema should not be attempted if signs of strangulated bowel, perforation, or toxicity are present Air insufflation of the colon under fluoroscopic guidance is a safe alternative to barium enema that has excellent diagnostic sensitivity and specificity without the risk of contaminating the abdominal cavity with barium)

What is the dx for intussusception?

liver biopsy ( high triglyceride content, mitochondria are swollen) Radiology - CT -Cerebral edema (history of ASA use during viral like illness?)

What is the dx for reye syndrome?

Upper GI endoscopy (is the most accurate diagnostic examination) Endoscopy (also provides the mechanism for testing of other causes of peptic symptoms such as esophagitis, eosinophilic GI disease, and celiac disease) (CD) (Endoscopic diagnosis of active H pylori infection may be achieved by histologic examination of gastric biopsies or measurement of urease activity on gastric tissue specimens) Gastrin level may be considered to evaluate for a gastrin-secreting tumor (Zollinger-Ellison syndrome) Upper GI barium radiographs may show an ulcer crater

What is the dx of PUD?

Stool Cultures (Five bacterial pathogens commonly produce gastroenteritis: Salmonella, Shigella, Yersinia, Campylobacter, and pathogenic E. coli Serotyping is useful for detecting E. coli O157, which is capable of inducing hemolytic uremic syndrome) Hematologic Tests (Give an idea as to hydration Significant variability in regards to age and body composition Serum glucose measurement is often essential) Imaging (Very limited role in pediatric acute gastroenteritis)

What is the dx tests for acute gastroenteritis?

(Respiratory Syncitial Virus) RSV (Less commonly human metapneumonvirus, parainfluenza, influenza, adenovirus, rhinovirus, M. pneumoniae)

What is the etiology of bronchiolitis?

parainfluenza virus RSV, influenza less common allergy (spasmodic)

What is the etiology of croup?

monospot (can take 10-14 days to be positive), titers, cbc, ESR (elevated in mono, not with strep)

What is the evaluation of EBV?

Meconium

What is the first intestinal discharge in newborns. It is composed of intestinal epithelial cells, intestinal secretions (bile), and water - but NO microbes. Intrauterine distress may cause discharge of meconium into the amniotic fluid prior to delivery. This condition usually affects infants older than a gestational age of 34 weeks. in the amniotic fluid can be detected in 8-20% of all birth after 34 weeks' gestation. Of this group above, 1-9% may develop Aspiration Syndrome. This disease affects both genders equally, and does not have a racial predilection.

Oral Rehydration Therapy

What is the first-line treatment for most children with acute gastroenteritis?

UGI (Confirmed by barium enema Plain films of the abdomen in the newborn period may show an intestinal obstruction CT scan and ultrasound of the abdomen may be used to make the diagnosis as well Labs are nonspecific)

What is the gold standard for dx for midgut malrotation and will show the duodenum remaining on the rt side of the abdomen-absence of C-loop?

Coxsackievirus

What is the hand-foot-mouth dz?

0.9% NS (Evaluate Recovery: Measure electrolytes every 4-6 hours for the first 24 hours Ensure that plasma sodium does not fall >12 mmol/L in 24‑hours)

What is the management of hypernatremia that develops during IV fluid therapy when the kid is dehydrated?

0.45% NaCl (Evaluate Recovery: Measure electrolytes every 4-6 hours for the first 24 hours Ensure that plasma sodium does not fall >12 mmol/L in 24‑hours)

What is the management of hypernatremia that develops during IV fluid therapy when the kid is not dehydrated?

2400 mL

What is the max maintenance of fluid in kids in 24 hours?

Asthma

What is the most common chronic dz of childhood?

Ventral Septal Defect

What is the most common congenital heart defect?

Pansystolic LLSB

What is the murmur presentation with VSD?

Continuous Machine like murmur at left infraclavicular space (sometimes with thrill present)

What is the murmur with PDA?

SEM Right Second Intercostal Space Radiating to neck

What is the murmur with aortic stenosis?

Pulmonary Stenosis murmur Right Ventricular Impulse Left Sternal Border

What is the murmur with tetralogy of fallot?

SEM LUSB and a mid-diastolic murmur at LLSB

What is the murmur with total anomalous pulmonary venous return?

SEM and left sternal border

What is the murmur with truncus arteriosus?

Maculopapular rash Snuffles Mucous patches on the oropharynx Hepatosplenomegaly with jaundice Chorioretinitis

What is the neonatal presentation for treponema pallidum?

39-42 weeks

What is the normal gestation?

CBC with differential Blood type & Rh UA with C&S Rubella antibody titer Hepatitis B & C antibody screen HIV GC & Chlamydia testing

What is the prenatal screening for every mother to be?

High BP Femoral pulses weak/delayed compared to radial pulses

What is the presentation with coarctation of the aorta?

Lecithin

What is the primary lipid in the composition of surfactant?

Parenteral preferred Benzathine penicillin (q 21-28 days <27 kg 600,000 units IM >27 kg 1.2 million units IM May use Sulfadiazine Penicillin V Erythromycin) 3-5 years

What is the prophylaxis with rheumatic fever and how long should therapy continue?

Erythema infectiosum

What is the rash with Exanthems: Fifths Dz Parvovirus B19?

Eradicate GABHS infection (<27 kg Benzathine penicillin 600,000 units IM once >27 kg Benzathine penicillin 1.2 million units IM once May use Penicillin V or erythromycin) Ant-inflammatory agents (Aspirin 30-60 mg/kg/day in four divided doses Treat for 2-6 weeks Other NSAIDs not as effective Corticosteroids not indicated)

What is the rheumatic fever treatment with acute exacerbation?

Triple Screen Blood Type antibody screen Ultrasound

What is the screening for 2nd trimester?

(35% small close spontaneously) Prophylactic antibiotics (prevent endocarditis) Large = diuretics and digoxin (Most Moderate to large are closed surgically but some can be closed with patch devices placed via cardiac catherization)

What is the treatment for VSD?

Fluticasone nasal spray (1 spray each nostril 2X daily-do not give oral antihis makes drainage worse leading to bacterial infection but okay with allergic rhinitis)

What is the treatment for viral sinusitis in a child?

Debridement Topical antibiotics (avoid neomycin-can cause allergic rx) Alcohol/vinegar if mild (also used for prevention)

What is the treatment of otitis externa?

Prophylaxis (for bacterial endocarditis for nonsecundum ASD's.) If >3 years and shunt still present surgical / nonsurgical closure recommended (Secundum usually closure device via cardiac catherization Primum and Sinus Venosus defects require surgery.) (Long-term prevention of death and complications best achieved when ASD is closed before 25 y/o and systolic pressure in main pulmonary artery is < 40 mmHg Long term effects on damage to lung arteries. )

What is the tx for ASD?

Reflux resolves spontaneously (in 85% of affected infants by 12 months of age, coincident with assumption of erect posture and initiation of solid feedings Regurgitation volume may be reduced by offering small feedings at frequent intervals and by thickening feedings with rice cereal (2-3 tsp/oz of formula) available) Acid suppression may be used for GERD (Therapeutic options include histamine-2 (H2)-receptor antagonists or proton pump inhibitors (PPIs) PPI therapy has been shown to significantly heal both esophageal mucosal injury and symptoms from GERD within an 8- to 12-week period There is no sufficient evidence to support the routine use of prokinetic agents for treatment of pediatric GERD)

What is the tx for GER?

A galactose-free diet should be instituted as soon as the diagnosis is made Compliance with the diet must be monitored by following galactose-1-phosphate levels in red blood cells (Appropriate diet management requires not only the exclusion of milk but an understanding of the galactose content of foods Avoidance of galactose should be lifelong with appropriate calcium replacement, intake of which tends to be low due to the restriction of dairy products)

What is the tx for Galactosemia?

Intravenous immunoglobulin (IVIG) (2g/kg IV over 10-12 hours once) High-dose aspirin (80-100 mg/kg/day in 4 divided doses Duration institution dependent Continue 48-72 hours after patient afebrile) Low-dose aspirin (3-5 mg/kg/d in 4 divided doses Continue 6-8 weeks) (Follow-up depends on coronary involvement None or minimal echo in 2 weeks and again at 6-8 weeks Moderate to severe individualized)

What is the tx for Kawasaki Dz?

Acid suppression or neutralization is the mainstay of noninfectious ulcer therapy (H2-receptor antagonists and PPIs are more effective and usually produce endoscopic healing in 4-8 weeks. As an adjunct therapy, 7- to 14-day courses of sucralfate may be helpful as a mucosal protective agent to speed healing and decrease symptoms Foods causing pain should be avoided Aspirin, alcohol, NSAIDs, and other gastric irritants should be avoided as well) H pylori infection requires eradication of the organism (The optimal medical regimen is still undetermined The most common regimen is a triple/quadruple combinations Amoxicillin, clarithromycin, and PPI (additional antibiotic for quadruple therapy) Bismuth subsalicylate is commonly used as a substitute for the PPI Regimens are typically continued for a minimum of 10 days) Endoscopic therapy of bleeding ulcers may be considered for severe or refractory lesions (Injection therapy, application of monopolar or bipolar electrocoagulation, placement of clipping devices, or use of argon plasma coagulation)

What is the tx for PUD?

Exploratory laparotomy (can be considered if the diagnosis cannot be ruled out) Laparoscopic (approach is recommended for nonruptured, uncomplicated cases)

What is the tx for acute appendicitis in children?

preventing or treating dehydration, replacing ongoing fluid losses, and meeting nutritional needs (ORT/IVRT Oral Rehydration Therapy Intravenous Rehydration Therapy Antiemetics-give Zofran-tablets dissolve)

What is the tx for acute gastroenteritis?

Nasal steroids (fluticasone) anti-histamines (Zyrtec, Claritin, etc.)

What is the tx for allergic rhinitis in children?

Activated charcoal should be used to reduce drug absorption Physostigmine (0.5-2.0 mg IV, slowly administered) (dramatically reverses the central and peripheral anticholinergic effects of antihistamines, but it should be used only for diagnostic purposes in patients without cardiotoxicity or seizures) Benzodiazepines (can be used to control seizures or agitation) (Cardiac dysrhythmias and hypotension should be treated with normal saline at a dose of 10-20 mg/kg and a vasopressor if necessary) Sodium bicarbonate (may be useful if there is QRS widening)

What is the tx for antihistamines?

Balloon Valvuloplasty Surgical Management Prophylaxis Endocarditis

What is the tx for aortic stenosis?

Diuretics, Digoxin, Surgical Repair is a must. Endocarditis prophylaxis (Surgical repair requires patching the septum. It also requires reconstruction of tricuspid and mitral valves. Valves made bc don't have them)

What is the tx for atrioventricular canal defects?

IV Prostaglandin E1 infusion (for decompensating infants)[opens ductus arteriosus] Inotropic agents, diuretics Surgical Repair / Catherization (balloon) Endocarditis prophylaxis.

What is the tx for coarctation of the aorta?

Hydration Tummy Massage Leg Exercises Warm bath Probiotics Diluted Fruit Juice (prune, pear, or apple) Increase fiber (apples, pears, peas, prunes, spinach, peaches, carrots, oatmeal) Rectal stimulation (take a temperature) Stool softener (Karo Syrup 1 tsp. in 2 oz. water twice a day until bowel moves)

What is the tx for constipation in children?

controlled intubation with anesthesia on emergency basis; antibiotics (cefuroxime) (Don't stick tongue depressor back there can cause spasm and cause them to suffocate)

What is the tx for epiglottitis?

Team approach: Pediatrician, Social Worker, Nutritionist Address organic & nonorganic causes High calorie diet Food diaries Frequent weight checks

What is the tx for failure to thrive?

Emergency treatment: IV glucose (Rapid administration of bolus IV glucose followed by infusion of IV glucose Allows suppression of the catabolic states and prevents further decompensation in patients with metabolic disorders) For adrenal insufficiency, stress doses of glucocorticoids should be administered (If low blood glucose is not treated immediately with simple sugar, the hypoglycemia may result in loss of consciousness and seizures; brain damage or death can occur with prolonged hypoglycemia)

What is the tx for hypoglycemia?

Rates of successful reduction by pneumatic reduction (approach 75%) Surgery is required for extremely ill patients (in patients with evidence of bowel perforation, or in those in whom hydrostatic or pneumatic reduction has been unsuccessful (25%) Surgery has the advantage of identifying a lead point such as Meckel diverticulum, lymphoma, or small bowel polyp Associated with a lower recurrence rate than pneumatic reduction)

What is the tx for intussusception?

SABA PRN

What is the tx for mild intermittent asthma in children?

SABA PRN Low dose ICS

What is the tx for mild persistent asthma in children?

SABA PRN LABA ICS low dose

What is the tx for moderate persistent asthma in children?

Supportive therapy Antibiotics (do not shorten the course of illness but do decrease severity and prevent spread) Azithromycin Erythromycin Clarithromycin Bactrim Vaccination (scheduled and with outbreaks. Highest morbidity in those too young to be vaccinated. DTaP)

What is the tx for pertussis?

Balloon Valvuloplasty Surgical Repair Endocarditis Prophylaxis

What is the tx for pulmonary valve stenosis?

SABA PRN LABA ICS High dose

What is the tx for severe persistent asthma in children?

O2 Place child knee to chest Morphine Phenylephrine, propranolol Complete Surgical Repair (close VSD patch, pulmonary stenosis) Palliative shunt surgery (Subclavian artery/aorta and pulmonary artery with complete repair later) Endocarditis prophylaxis.

What is the tx for tetralogy of fallot?

Prostaglandin E1 (maintain a patent PDA) Endocarditis prophylaxis Surgical Correction Staged (Blalock-Taussig Procedure Bidirectional Glenn and Fontan Procedure)

What is the tx for tricuspid atresia?

Diuretic Endocarditis Prophylaxis Surgical Repair (VSD closure and conduit between RV and pulmonary arteries)

What is the tx for truncus arteriosus?

SABA PRN OCS LABA ICS High dose

What is the tx for very severe persistent asthma in children?

Spontaneous closure. (rare after 5 months) (indomethacin, ibuprofen, and other NSAIDs have been used in neonates to close the inappropriately patent ductus. Only works early on. Usually IV) (Prophylactic abx. All recommended closure due to risk of endocarditis. Most closed via closure devices by catherization. Some closure surgical with suture ligation or clip from incision between ribs on left side of chest.)

What is the tx of PDA?

Inpatient therapy consists of: Inhaled short-acting beta agonists (SABAs),(with frequency of administration anywhere from continuously to every four hours, depending upon the patient's degree of illness) Systemic glucocorticoids Supplemental oxygen (as necessary to maintain oxygen saturation ≥92 percent) Asthma education Initiation or adjustment of controller agents, based upon classification of severity and/or control

What is the tx of asthma?

Mild illness: manage at home Cool mist (tent may increase anxiety and interfere with observation) Hydration, minimal disturbance - keep calm Systemic steroids (dexamethasone 0.3 - 0.6 mg/kg IM or PO x 1 dose; or prednisone-liver breaks that down to prednisolone the active form but children have immature hepatocytes so give them the active form/prednisolone for several days) Racemic epinephrine ( every 1-2 hours Observe for minimum 2-4 hours Hospitalize if more than 1 treatment needed)

What is the tx of croup in children?

In the absence of fever or illness -BRAT diet Complex carbs and fiber (fruit/veggies) Avoid diarrhea causing foods.

What is the tx of diarrhea?

The NG tube in the proximal pouch should be placed on low intermittent suction(-high force do damage to tissue and esophagus- to drain secretions and prevent aspiration) The head of the bed should be elevated (to prevent reflux of gastric contents through the distal fistula into the lungs) IV glucose and fluids (should be provided and oxygen administered as needed) Definitive treatment is surgical - divide and ligate the fistula and approximate the esophagus, create anastamosis if possible (Prognosis is poor as the reconstructed esophagus is prone to poor motility and recurrent fistula; tracheomalacia and wheezing is common)

What is the tx of esophageal astresia?

Surgical treatment of malrotation is the Ladd procedure (Because volvulus can occur at any age, surgical repair is usually recommended, even in asymptomatic children Laparoscopic repair of malrotation is possible but is technically difficult and is never performed in the presence of volvulus)

What is the tx of midgut malrotation?

is aimed at maintaining phenylalanine levels less than 360 μM (6 mg/dL) (Dietary restriction of phenylalanine Increasing enzyme activity with pharmacologic doses of R-tetrahydrobiopterin New methods to interfere with phenylalaine absorption or to breakdown phenylalanine.) Dietary restriction of phenylalanine intake (to amounts that permit normal growth and development is the most common therapy and results in good outcome if instituted in the first month of life and carefully maintained Metabolic formulas deficient in phenylalanine are available but must be supplemented with normal milk and other foods to supply enough phenylalanine to permit normal growth and development Serum phenylalanine concentrations must be monitored frequently while ensuring that growth, development, and nutrition are adequate)

What is the tx of phenylketonuria?

Treatment is surgical (Treatment of dehydration and electrolyte imbalance is mandatory before surgical treatment Use of IV cimetidine and other acid-blocking agents has been shown in small studies to rapidly correct metabolic alkalosis) Laparoscopic pyloromyotomy (Pyloric muscle is incised longitudinally to release the constriction Care is taken to spare the mucosa)

What is the tx of pyloric stenosis?

SUPPORTIVE monitor patients LFT's, electrolytes, vital signs and physical exam manage ICP, coagulopathy and seizures, dialysis for elevated ammonia levels (Steroids can be used to reduce swelling in the brain) (PREVENTION ? inform teenagers not to take aspirin inform parents not to give aspirin to children) (ASA, acetylsalicylic acid = aspirin )

What is the tx of reye syndrome?

Prostaglandin E1 (maintain ductal patency) Diuretics/Pacemaker Surgical Repair Early. (survival time if no mixing is only days) Endocarditis prophylaxis

What is the tx of transposition of great arteries?

TMP/SMZ Cefixime

What is the tx of uncomplicated UTI in children?

Blood and Urine Cultures CXR WBC, Platelet Count (greatly elevated subacute phase), and ESR Lumbar puncture Hepatobiliary function may be abnormal Echocardiography

What is the workup for Kawasaki Dz?

Specific toxin drug assays ABG Electrolytes Glucose (most important in CMP-diabetic meds most commonly ingested) Anion gap 12 lead ECG Urine drug screens (opioids, benzos)

What lab evals should you get with a poisoning case?

26-30 weeks gestation

What may include a 1 hour glucose tolerance test, hemoglobin and hematocrit, and Rh immune globulin administration if indicated?

Maintenance therapy

What replaces normal daily losses of water and electrolytes occurring via physiologic processes (urine, sweat, respiration, and stool)?

Cigarette smoking

What results in fetal exposure to carbon monoxide and nicotine, and this is thought to eventuate in a number of adverse pregnancy outcomes: Abruptio placentae Placenta previa Premature rupture of the membranes (PROM) Preterm delivery Low birth weight Ectopic pregnancy Pregnant women should also avoid exposure to environmental smoke ("passive smoking"), and smokeless tobacco, and e-cigarettes?

Inotropic and vasopressor agents Dopamine Norepi or epi Vasopressin Dobutamine Milrinone

What should be considered for patients with refractory shock despite receiving 60 mL/kg of fluid resuscitation? What remains an acceptable first-line vasopressor in the peds pop? What may be useful for dop-refractory shock? What may be considered as a rescue therapy for patients failing catecholamine infusions but has not been clearly shown to improve outcomes from severe sepsis in children? What may be used to improve myocardial contractility and reduce afterload? What can be added to other more potent inotropic agents?

Fluid Resuscitation

What should begin with 20 mL/kg increments administered over 5-10 minutes and repeated as necessary Fluid administration should be titrated to reverse hypotension and achieve normal capillary refill, pulses, level of consciousness, and urine output If pulmonary edema or hepatomegaly develop, inotropes should be used in place of more fluid, and cardiac function evaluated for evidence of cardiogenic shock Large volumes of fluid for acute stabilization in children with hypovolemic or septic shock may be necessary to restore adequate oxygen delivery and do not increase the incidence of ARDS or cerebral edema Initial fluid resuscitation should consist of crystalloid (salt solution), which is readily available and inexpensive Children with hemolytic anemia crises who are hemodynamically stable should receive red blood cell transfusions

Treponema pallidum

What shows maternal transmission at any age, but typically considered at 16 weeks gestation Untreated risks include: Spontaneous abortion Stillbirth Neonatal death Neonatal presentation includes maculopapular rash Snuffles Mucous patches on the oropharynx Hepatosplenomegaly with jaundice Chorioretinitis

Retinoic Acids

What teratogens are associated with: CNS maldevelopment, especially of the posterior fossa Ear anomalies (often absence of pinnae) Congenital heart disease (great vessel anomalies) Tracheoesophageal fistula

Hep A#1, IPV #3 if not given, Prevnar #4, Varicella #1

What vaccines should you give to a kid 12 months old?

DTaP#4, Hib booster, MMR #1

What vaccines should you give to a kid 15 months old?

Vital signs

What will be assessed several times during the first hour of life with newborn PE?

Ground glass

What will be seen on a radiograph with respiratory distress syndrome?

Steeple sign

What will you see on AP x-ray of neck with croup?

34 weeks

When does meconium aspiration syndrome occur?

Canalicular

When is surfactant produced during what stage beginning at 16 wks of gestation?

12 months 2 years 3 years (also screen if child is at risk for anemia)

When should anemia be screened in children?

6 months 12 months Yearly (Screen if at risk and TB test for school as required)

When should you screen a baby for TB?

D5 Normal Saline (Need Sodium and Sugar-5% dextrose-contains 5g of dextrose per 100mL)

Which IV fluid is used for infants less than 10kg?

Diastolic

Which murmur is always abnormal, systolic or diastolic?

Bronchiolitis

Winter (Dec-March) ~50% of children by 2 yo Peak 2-6 mo old High Risk Groups History of prematurity Congenital heart disease Underlying lung disease Immune deficiency Severe neuromuscular disease Clinical Manifestations Apnea (infants) Cough Tachypnea Retractions Flaring, grunting Head bobbing Wheezes, crackles Cyanosis or pallor Evaluation Chest X-ray - hyperinflation; atelectasis per bronchiolar cuffing Pulse oximetry or ABG What is this?

Popliteal angle

With the infant lying supine, and with diaper removed, the thigh is placed gently on the infant's abdomen with the knee fully flexed. After the infant has relaxed into this position, the examiner gently grasps the foot at the sides with one hand while supporting the side of the thigh with the other. The leg is extended until a definite resistance to extension is appreciated. At this point the angle formed at the knee by the upper and lower leg is measured. What is this associated with the ballard scoring?

Scarf sign

With the infant lying supine, the examiner adjusts the infant's head to the midline and supports the infant's hand across the upper chest with one hand. The examiner nudges the elbow across the chest, felling for passive flexion or resistance to extension of posterior shoulder girdle flexor muscles. The point on the chest to which the elbow moves easily prior to significant resistance is noted. What is this w/ballard scoring?

Arm recoil

With the infant lying supine, the examiner places one hand beneath the infant's elbow for support. Taking the infant's hand, the examiner briefly sets the elbow in flexion, then momentarily extends the arm before releasing the hand. The angle of recoil to which the forearm springs back into flexion is noted. The extremely pre-term infant will not exhibit any WHAT What is this with the ballard scoring?

Square Window

Wrist flexibility and/or resistance to extensor stretching are responsible for the resulting angle of flexion at the wrist. The examiner straightens the infant's fingers and applies gentle pressure on the dorsum of the hand, close to the fingers. From extremely pre-term to post-term, the resulting angle between the palm of the infant's hand and forearm is estimated What is this associated with the ballard scoring?

Jaundice

Yellowing, or WHAT in the first 24 hours of life requires further evaluation.

Hospitalization

Young age (< 6 months) Moderate to marked respiratory distress Hypoxemia Apnea Inability to tolerate oral feeding Lack of appropriate care available at home High-risk children This with Bronchiolitis indicates what?

Genu Valgum (Knock Kneed), Genu Varum (Bow Legged)

Young children have a wide range of normal knee alignment At birth child has approx. 10-15⁰ genu varum Bowing straightens to 0⁰ at 12-18 months Continued growth produces genu valgum at age 3-4 of up to 10-15⁰ At adulthood average genu valgum is approx. 5-10⁰ What is this?

ARA

arachidonic acid Naturally found in human milk a 20-carbon omega-6 fatty acid necessary for the development of the nervous system What is this in formula?

Pubertal growth and physical development

are a result of activation of the hypothalamic-pituitary-gonadal axis in late childhood Before puberty, pituitary and gonadal hormone levels are low At onset of puberty, the inhibition of gonadotropin-releasing hormone in the hypothalamus is removed, allowing pulsatile production and release of the gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) In early to middle adolescence, pulse frequency and amplitude of LH and FSH secretion increase, stimulating the gonads to produce estrogen or testosterone

VSD (Ventral Septal Defect)

are often asymptomatic at birth and become symptomatic within 6 - 8 weeks due to Pulmonary vascular resistance decreasing over time, and the amount of shunt increases. Left to right shunt Get more deox blood to left side What is this?

STIs

are the most common infectious diseases in adolescents today, affecting 25% of all sexually active adolescents aged 13-19 years The younger the age of first intercourse, the higher is the risk for THIS Chlamydia is the most prevalent of the bacterial THIS Sequelae of chlamydial infections include pelvic inflammatory disease (PID), ectopic pregnancy, and infertility This age group accounts for 8% of cases of HIV in females HPV is the most common sexually acquired infection in the world, with a prevalence of 50% among young sexually active adolescents

Middle Adolescence

as rapid pubertal development subsides, teenagers become more comfortable with their new bodies Intense emotions and wide swings in mood are typical Cognitively, the WHAT moves from concrete thinking to formal operations and abstract thinking The teens are self centered, and relationships with peers and others are narcissistic Adolescents in this group may begin dating and experimenting with sex Peers determine the standards for identification, behavior, activities, and clothing and provide emotional support, intimacy, empathy, and the sharing of guilt and anxiety during the struggle for autonomy

Heart rate

averages 140 beats /minute and can range from 100-190 per minute and still be normal. IF very slow or very fast for an extended period of time, a further evaluation is warranted. What is this with newborn PE?

Foramen ovale

bypass tract between R and L atria (oxygentated blood from IVC shunts through here)

Ductus arteriosus

bypass tract between pulmonary artery and descending aorta (Oxygen poor blood shunts from Pulmonary artery to descending aorta)

Ductus venosus

bypass tract between umbilical vein and IVC (50% of oxygenated blood bypasses liver through this ) Blood moves from placenta toward the right heart.

Parvovirus B19

can cause devastating fetal outcomes, such as: Fetal anemia Spontaneous abortion Fetal nonimmune hydrops fetalis Death Overall risk is low specific IgM antibody is the preferred diagnostic test Treatment after birth is supportive What maternal infection is this?

Sickle Cell Trait

can participate in sports with certain guidelines Build up slowly in training with long periods of rest between reps Encourage participation in preseason strength and conditioning programs that are sport specific Avoid participation in performance tests (long runs/sprints) Stop activity with onset of symptoms (muscle 'cramping', pain, swelling, weakness, tenderness; inability to "catch breath", fatigue) Allow athletes to set their own pace Year round conditioning with periodized programs is needed High ambient temperature, dehydration, asthma, illness, and altitude predispose the athlete with sickle trait to an onset of crisis No workout if an athlete with sickle trait is ill Educate to create an environment that encourages athletes with sickle cell trait to report any symptoms immediately What is this associated with?

Pregnancy

come from low socioeconomic backgrounds and have poor education and perhaps poor general health due to inadequate nutrition, iron deficiency anemia, cigarette smoking, drug abuse, or STIs is the most common cause for females to drop out of school Teen THIS Requires early, consistent, and comprehensive prenatal care Evaluate the SES status to optimize the infant's health and development If termination is chosen, refer to a nonjudgmental abortion service Options for termination depend on gestational age Psychosocial support and subsequent contraceptive counseling and implementation should be available for adolescents who choose abortion

Cervical Spine Injuries

consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity. The spinal cord is located in the middle of the cervical spine and is protected by bony structures Sports-related cervical injuries can be categorized in the following terms: Acute cervical sprains/strains including whiplash injury Cervical fractures and dislocations Nerve root or brachial plexus injuries Intervertebral disc injuries Cervical stenosis What is this with PPE?

Molluscum contagisum

consists of umbilicated, flesh-colored papules in groups anywhere on the body

Reye syndrome

disease of the brain and liver non-inflammatory cerebral edema (encephalopathy) Fatty infiltration of the liver and kidneys cause unknown viral illness sequella (chicken pox, influenza and URI) originally thought to be associated with Aspirin and viral illness. This idea is in question. Presentation - prodrome of a viral illness; recovery period followed by: vomiting, irritability, aggressive behavior, lethargy, delirium, stupor, seizures, coma Exam - AMS, dilated pupils, hyperactive DTRs, Kussmaul's respirations. What is this?

Neuro

exam is done by observation. Certain primitive reflexes are present at birth, and if absent, may warrant further evaluation. They are as follows: - suck variable disappearance around 6 months - root variable disappearance - palmar and plantar grasp absent after 2-4 months - traction response absent after 2 months - placing response ( also called stepping reflex) absent first month, variable - Moro (also called startle reflex) absent after 4-6 months - asymmetric tonic neck reflex (ATNR) absent after 4 months - deep tendon reflexes (DTRs) +Babinski is normal until 18 months of age, other reflexes may be brisk What newborn PE is this?

MMR

given at 12-15 months and again at 4-6 years MMRV (ProQuad) is preferred at 4-6 years due to increased risk of febrile seizures at 12-15 months. In child bearing age, pregnancy ruled out and woman advised against conception 3 months after vaccination Measles can cause seizures, pneumonia, brain damage, and death occurs 1-2 in every 1,000 diagnosed. CI/Precaution: Contraindicated in pregnancy within 28 days, immunocompromised, and anaphylactic egg or neomycin allergy, children receiving high-dose corticosteroid therapy Leukemia patients in remission and 3 months post chemo can get MMR and MMRV safely HIV patients should get two doses as long as CD-4 count within good range Personal or family history of febrile seizures considered a precaution of the use of MMRV and separate vaccines are preferred Adverse Reaction: Fever 39.5C or higher 6-12 days after vaccination lasting 1-2 days Transient morbiliform rash and thrombocytopenia Encephalitis, aseptic meningitis, Guillain-Barre Arthalgia and arthritis Rare-peripheral neuritis, neuropathy, transverse myelitis Increased risk of febrile seizure 8-14 days after vaccination with first dose Risk of febrile seizure with use of MMRV is twice that of using separate vaccines in 12-23 month population What vaccine is this?

Type 2 Diabetes

has a strong genetic component Risk Factors: Obesity, particularly central Lack of exercise Low SES Family dysfunction Psychiatric disorders Obesity, T2D, and associated insulin resistance adversely affect cardiovascular health Polyuria Polydipsia Metabolic syndrome Possibly Acanthosis Nigricans What is this?

Sickling collapse

has been mistaken for cardiac collapse or heat collapse Core temperature is not affected May occur early in activity (during initial sprints) Slump to ground with weak muscles, with little to no cramping Pain is not severe Muscles look normal Some players just stop activity -"I can't go on" As the player rests, sickle red cells regain oxygen in the lungs and most then revert to normal shape, and the athlete soon feels good again and ready to continue This self-limiting feature may saves lives What is this?

Chronic functional constipation

in childhood is defined as two or more of the following characteristics for 2 months: Fewer than three bowel movements per week More than one episode of encopresis per week Impaction of the rectum with stool Passage of stool so large it obstructs the toilet Retentive posturing and fecal withholding Pain with defecation

DKA

includes abdominal pain, nausea, and vomiting that can mimic an acute abdomen The patients are mildly to moderately dehydrated (5%-10%) They may have Kussmaul respiration, and become progressively somnolent and obtunded Acetoacetate is converted to acetone and is responsible for the classic breath odor of nail polish The distribution of diagnosis has shifted to younger age; infants, toddlers, and preschool age children are at particular risk A heavy diaper in a dehydrated child without diarrhea should always flash an alarm What presentation is this for?

Small for Gestational Age (SGA)

infants have birth weights below the 10th percentile for the population's birth weight-gestational age relationship WHAT infants include constitutionally small infants and infants with intrauterine growth restriction Result of poor maternal environment, intrinsic fetal abnormalities, congenital infections, or fetal malnutrition Shown to be at increased risk for neonatal death Infants of women who participate in regular aerobic exercise programs have lower average birthweights compared with infants in the general population but no demonstrable adverse effects

Paroxysmal

intense coughing lasting for several minutes. Infants and toddlers exhibit the characteristic inspiratory whoop as they inhale forcefully through a narrowed airway. Babies may not "whoop" but may have periods of apnea. Post-tussive emesis and red face is common. What stage of pertussis is this?

Sickle Cell Trait

is a condition in which a person has one abnormal allele of the hemoglobin beta gene(heterozygous), but does not display the severe symptoms of sickle cell disease(homozygous) Those with THIS produce both normal and abnormal hemoglobin is generally regarded as a benign condition Individuals may have rare complications Complications may be greater in exercise Acute rhabdomyolysis tied to THIS is one of the leading causes of death in young athletes Physio: Sickle hemoglobin can change shape during intense or extensive exercise (sickling) Sickle cells can "logjam" blood vessels and lead to collapse from ischemic rhabdomyolysis Rhabdomyolysis is the rapid breakdown of muscle protein when starved of oxygenated blood Sickling can begin in 2-3 minutes of any all-out exertion Heat, dehydration, altitude, and asthma can increase the risk for and worsen sickling, even at lower levels of exercise Sickling collapse is a medical emergency What is this?

Acute (Surgical) Abdomen

is a constellation of findings indicating an intra-abdominal process that may require surgery The pain intensifies over time and is rarely relieved without definitive treatment Often accompanied by nausea, vomiting, diarrhea, fever, and anorexia Pain may be localized or generalized The abdomen may be distended and tense, and bowel sounds reduced or obstructive Patients appear ill and are reluctant to be examined or moved is usually a result of infection of the intra-abdominal or pelvic organs, but it also occurs with intestinal obstruction, intestinal perforation, inflammatory conditions, trauma, and some metabolic disorders

Osteosarcoma

is a deadly form of musculoskeletal cancer that most commonly causes patients to die of pulmonary metastasis is the most common malignant bone tumor is thought to arise from primitive mesenchymal bone-forming cells, and its histologic hallmark is the production of malignant osteoid arise as solitary lesions within the fastest growing areas of the long bones of children (growth plates) Incidence increases steadily with age and rises dramatically in adolescence in correspondence with the adolescent growth spurt Risk factors: Genetic predisposition, bone dysplasias (Paget disease, fibrous dysplasia, enchondromatosis), retinoblastoma The most common sites are: Femur (42%, 75% of which are in the distal femur) Tibia (19%, 80% of which are in the proximal tibia) Humerus (10%, 90% of which are in the proximal humerus) Skull and jaw (8%) Pelvis (8%) What is this?

Biophysical Profile

is a non-invasive test that can predict the presence or absence of asphyxia, and perhaps, the risk of fetal death. The five parameters of a WHAT include the following: - the non-stress test - ultrasound measurement of the amniotic fluid volume - observation of fetal breathing movements - gross body movements - tone Normal receives a score of 2 points, abnormal scores 0.

Heat Related Illness

is a set of preventable conditions ranging from mild forms like heat exhaustion & heat cramps to potentially fatal heat stroke Intrinsic Factors History of exertional heat illnesses Inadequate acclimatization Lower level of fitness status Higher percent body fat Dehydration or over-hydration Presence of a fever or gastrointestinal illness Salt deficiency Skin condition (e.g., sunburn, skin rash, etc.) Ingestion of certain medications (e.g., antihistamines, diuretics, etc.) Motivation to push oneself/warrior mentality/reluctance to report problems, illness, etc. Pre-pubescence Extrinsic Factors Intense or prolonged exercise with minimal breaks High temperature/humidity/sun exposure Inappropriate work/rest ratios based on intensity, wet bulb globe temperature (WBGT), clothing, equipment, fitness and athlete's medical condition Lack of education and awareness of heat illnesses among coaches, athletes and medical staff No emergency plan to identify and treat exertional heat illnesses No access to shade during exercise or during rest breaks Duration and number of rest breaks is limited Minimal access to fluids before and during practice and rest breaks Delay in recognition of early warning signs What is this?

Transient Synovitis

is a sterile effusion of the synovial fluid of the joint that resolves without treatment or sequelae (self-limiting) Usually age 2-5 years Unknown etiology. No known infectious--either bacterial or viral--cause Clinical Presentation Sudden onset of hip pain with limp or refusal to walk Typically pain in groin or proximal thigh Physical Examination Limping, mild restriction of hip motion Usually afebrile Diagnostic Tests Diagnosis of exclusion Radiographs and lab results are usually normal Joint effusion on ultrasound Aspirate joint if concern for septic arthritis Treatment Rest, monitor temperature NSAIDS, pain control Patients typically improve in 3-5 days What is this?

Nonstress test

is a test of fetal conditioning, and used to describe fetal heart rate acceleration in response to fetal movement as a sign of fetal health This test involved the use of Doppler-detected fetal heart rate acceleration coincident with fetal movements perceived by the mother Currently, THIS is the most widely used primary testing method for assessment of fetal well-being and has also been incorporated into the biophysical profile testing system subsequently discussed What is this with fetal surveillance?

DKA

is an absolute or relative insulin deficiency that results in the inability of cells to take up and utilize glucose Levels of counterregulatory hormones are elevated, which drives many of the physiologic disturbances observed in DKA These hormones increase glucose production by promoting glycogenolysis, gluconeogenesis, lipolysis, and ketogenesis, and further decrease glucose utilization by antagonizing insulin As the serum glucose level exceeds the renal absorption threshold, an obligatory osmotic diuresis ensues, which results in the classic symptoms of polyuria and polydipsia *If not recognized early, this can lead to profound dehydration and electrolyte disturbances* Acidosis stems from the complex metabolic derangements induced by insulin deficiency and unopposed glucagon Decreased lipid uptake by adipose tissue and increased lipolysis results in an overabundance of circulating free fatty acids, which are converted by the liver into the ketoacids acetoacetate and β-hydroxybutyrate. What pathophys is this for?

Scarlet Fever

is an illness caused by toxin-producing group A β-hemolytic streptococci Raised, lacy, "sandpaper" rash, accentuated in the skinfolds Strawberry tongue may be observed in patients with scarlet fever, and usually develops within the first 2 to 3 days of illness A white or yellowish coating usually precedes the classic red tongue with white papillae

Osteomyelitis

is an infection in bone that is usually bacterial in origin Usually hematogenous seeding from another infectious site Can result from direct contamination like an open fracture, or puncture wound Most commonly located in metaphysis of long bones May be sub-acute presentation after 1 or more months of infection Clinical Presentation Pain, swelling, tenderness, erythema, warmth, general malaise Refusal to use affected limb Physical Examination Fever T>100.4⁰F Tenderness in involved region Limited ROM (not as limited as with septic arthritis) Diagnostic Tests AP and lateral radiographs of affected area Early radiographs may be normal or show soft tissue swelling Help to rule out tumor or fracture Osseous changes may be present on x-ray after 7-10 days Further Diagnostic Studies MRI and bone scan may be necessary if diagnosis is suspected or unclear Abscess and periosteal elevation may be seen on U/S Aspiration can be performed if the site is accessible and neoplasm has been ruled out. Aspiration will confirm diagnosis and guide antibiotic therapy Lab tests: CBC with diff and ESR will confirm inflammatory process. C-reactive protein is helpful in monitoring response to treatment Blood culture will identify the causative agent in 40-50% of patients What is this?

Congenital Adrenal Hyperplasia

is an inherited genetic defect that limits production of one of the many enzymes the adrenal glands use to make cortisol The enzyme most commonly lacking in THIS is 21-hydroxylase Signs and symptoms of THIS are worst when the enzyme deficiency is severe Mineralcorticoid outer, glucocorticoid-cortisol, sex hormones, catecholamines What is this?

IV Rehydration Therapy

is appropriate and necessary in children with severe dehydration, hemodynamic compromise, or when altered mental status precludes safe oral administration of fluid A 20-mL/kg bolus of isotonic fluid should be given intravenously as rapidly as possible. Either colloid (5% albumin) or crystalloid (normal saline or Ringer lactate) may be used Colloid is particularly useful in hypernatremic patients in shock, in malnourished infants, and in neonates If no intravenous site is available, fluid may be administered intraosseously through the marrow space of the tibia What is this?

Physical Abuse

is based on the presence of a discrepant history, in which the history offered by the caregiver is not consistent with the clinical findings The discrepancy may exist because the history is absent, partial, changing over time, or simply illogical or improbable The presence of a discrepant history should prompt a request for consultation with a multidisciplinary child protection team or a report to the child protective services agency This agency is mandated by state law to investigate reports of suspected child abuse and neglect Investigation by social services and possibly law enforcement officers, as well as a home visit, may be required to sort out the circumstances of the child's injuries a detailed psychosocial history is important because psychosocial factors may indicate risk for or confirm child maltreatment This history should include information on who lives in the home, other caregivers, domestic violence, substance abuse, and prior family history of physical or sexual abuse Inquiring about any previous involvement with social services or law enforcement can help to determine risk

Congenital adrenal hyperplasia (CAH)

is caused by mutations in genes encoding steroidogenic enzymes involved in glucocorticoid synthesis (CYP21A2, CYP17A1, HSD3B2, CYP11B1) or in the cofactor enzyme P450 oxidoreductase that serves as an electron donor to CYP21A2 and CYP17A1 Leads to increased ACTH secretion which results in adrenal hyperplasia with increased production of adrenal hormone precursors Mutations in CYP21A2 are the most prevalent cause of CAH (90%) Patients affected by CAH exhibit glucocorticoid deficiency Depending on the exact step of enzymatic block, they may also have excess production mineralocorticoids or deficient production of sex steroids The degree of impairment of glucocorticoid and mineralocorticoid secretion depends on the severity of mutations

Esophageal atresia

is characterized by a blind esophageal pouch with or without a fistulous connection between the proximal or distal esophagus (or both) and the airway In 85% of infants, the fistula is between the distal esophagus and the airway A single artery umbilical cord is frequently present at birth Polyhydramnios is common because of high GI obstruction Incidence is approximately 1 in 3000 births

Early adolescence

is characterized by rapid growth and development of secondary sex characteristics Body image, self-concept, and self-esteem fluctuate dramatically Concerns about how personal growth and development deviate from that of peers may be great Although there is a certain curiosity about sexuality, young adolescents generally feel more comfortable with members of the same sex Peer relationships become increasingly important Young teenagers still think concretely

Gastrroesophageal reflux (GER)

is common in young infants and is a physiological event Frequent postprandial regurgitation, ranging from effortless to forceful, is the most common infant symptom Infant THIS is usually benign, and it is expected to resolve by 12-18 months of life Infants with suspected physiologic THIS do not require further evaluations unless there is clinical concern for complicated GERD or non-reflux diagnoses Factors promoting reflux in infants include: Small stomach capacity Frequent large-volume feedings Short esophageal length Supine positioning Slow swallowing response to the flow of refluxed material up the esophagus

Perinatal Time Period

is defined as 20th week gestation until 28 day post delivery. In certain situations of increased risk, a biophysical profile will be done to determine the well-being of the fetus, and to assess the need for immediate delivery.

Large for Gestational Age (LGA)

is defined as EFW above the 90th percentile for any specific gestational age Generally associated with fewer maternal and fetal complications than IUGR Factors: Maternal: Diabetes (gestational, chemical, or insulin-dependent), obesity, postdatism, multiparity, advanced age, previous LGA infant, large stature Fetal: Genetic or congenital dz, male gender

Hypoglycemia

is defined as a blood glucose level below 60 mg/dL (3.3 mmol/L) Based on: Low serum glucose concentrations Symptoms compatible with hypoglycemia Resolution of symptoms after administration of glucose Blood glucose levels less than 45 mg/dL need immediate intervention Decreased serum glucose leads to suppression of insulin secretion and increased secretion of GH, cortisol, glucagon, and epinephrine This promotes release of amino acids from muscle to fuel gluconeogenesis Stimulates the breakdown of hepatic glycogen and promotes gluconeogenesis Hyperinsulinemia Commonly seen at birth in mother with diabetes Resolves rapidly, and uncommon beyond the neonatal period Defects in Counter-regulatory Hormones GH and/or cortisol (Relates to hypopituitarism) Typically hypoglycemic infants with facial or neurologic defects, pendular (roving) nystagmus, and the presence of microphallus and cryptorchidism in boys Defects in Energy Stores Need glycogen, adipose tissue, and muscle Defects in metabolic response pathways Glycogenolysis (G6PD), Gluconeogenesis, Fatty Acid Oxidation (CoA dehydrogenase deficiency) Medications Insulin, oral hypoglycemic agents, propranolol, salicylate intoxication What is this?

Congenital Pneumonia

is defined as an inflammatory pulmonary process that may originate in the lung, or be part of a systemic process. Gas exchange may be impaired as a result of this process, and cause a derangement in cellular metabolism. The causative organism depends on the mode of transmission: 1. trans-placentally-small tear-something in placenta 2. ascending infection 3. aspiration Organisms include: Group B Strep E. coli Listeria monocytogenes H. Influenza Staphylococcus aureus STDs-Chlamydia Others It has a higher occurrence in settings where there are maternal pathologies, prematurity and meconium in the amniotic fluid. It may occur at any gestational age, and has no racial or gender predilection. What is this?

Hyperthyroidism

is defined as excessive production of thyroxine with a depressed (usually undetectable) serum TSH level Spontaneous abortion, preterm birth, preeclampsia, and maternal heart failure occur with increased frequency with untreated thyrotoxicosis Thyroid storm, although rare, can be a life-threatening complication Neonatal hyperthyroidism is due to transplacental passage of thyroid-stimulating antibodies, and includes the following symptoms: IUGR Prematurity Goiter - leading to tracheal obstruction Exophthalmos Craniosynostosis Flushing Heart failure Tachycardia Arrhythmia Hypertension Hypoglycemia Thrombocytopenia hepatosplenomegaly Medical treatment of thyrotoxicosis is usually accomplished with the antithyroid drugs and beta blockers Fetal hypothyroidism or hyperthyroidism is uncommon but can occur with maternal Graves disease, which is the most common cause of hyperthyroidism in pregnancy Radioiodine ablation is absolutely contraindicated in pregnancy because it may destroy the fetal thyroid as well

Sexual Abuse

is defined as the engaging of dependent, developmentally immature children in sexual activities that they do not fully comprehend and to which they cannot give consent, or activities that violate the laws and taboos of a society It includes all forms of incest, sexual assault or rape, and pedophilia This includes fondling, oral-genital-anal contact, all forms of intercourse or penetration, exhibitionism, voyeurism, exploitation, or prostitution, and the involvement of children in the production of pornography Although over the past decade, there has been a small downward trend nationally in total reports of sexual abuse cases, exploitation and enticement of children and adolescents via the Internet and social media remains a growing trend

Encopresis

is defined as the repeated passage of stool into inappropriate places (such as in the underpants) by child who is chronologically or developmentally older than 4 years Children with THIS exhibit abnormal anorectal dynamics, such as a weak internal sphincter, or a failure of the external sphincter to relax in concert with rectal contraction waves and abdominal straining There are two types of THIS: With constipation and overflow incontinence Without constipation and overflow incontinence Treat the underlying constipation, THIS will resolve

GERD

is diagnosed when reflux causes persistent symptoms with or without inflammation of the esophagus Poor growth, pain, respiratory problems Older children with THIS complain of adult-type symptoms: Regurgitation into the mouth Heartburn Dysphagia Esophagitis can occur as a complication of THIS and requires endoscopy with biopsy for diagnostic confirmation Children with asthma, cystic fibrosis, developmental handicaps, hiatal hernia, and repaired tracheoesophageal fistula are at increased risk of THIS and esophagitis

Ibuprofen

is given in a dosage of 10 mg/kg of body weight per dose and can be given every 6-8 hours Can be used in children 6 months and older What antipyretic is this?

Acetaminophen

is given in a dosage of 15 mg/kg of body weight per dose and can be given every 4-6 hours Acetaminophen is indicated in children older than 2 months who have fever of 39°C or are uncomfortable What antipyretic is this?

Legg-Calve-Perthes Disease (LCPD)

is idiopathic osteonecrosis of the femoral head in children Clinical Presentation Limping Worsening pain with activity *Groin and proximal thigh pain* Physical Examination Decreased hip motion, particularly abduction Diagnostic Tests Hip x-ray- AP and frog lateral Increased density of femoral head (early sign) Crescent sign MRI- osteonecrosis What is this?

Scoliosis

is lateral curvature of the spine of greater than 10⁰ Can occur in thoracic or lumbar spine (or both) May be associated rotation of vertebrae and sometimes excessive kyphosis or lordosis Most commonly idiopathic but may be secondary to other problems Secondary causes: Congenital Failure of formation (hemivertebra), failure of segmentation (bony bar joining adjacent vertebrae) Neuromuscular Cerebral palsy, muscular dystrophy, myelomenigocele, spinal muscular atrophy, spinocerebellar degeneration Vertebral Disease Tumor, infection, metabolic bone disease Spinal Cord Disease Tumor, syringomyelia Disease Associated Neurofibromatosis, Marfan syndrome, connective tissue disorders What is this?

Fever

is one of the most common reasons for pediatric office visits, emergency department encounters, and after-hours telephone calls

Thyroid Cancer

is rare in childhood Children usually present with a thyroid nodule or an asymptomatic asymmetrical neck mass Dysphagia and hoarseness are unusual symptoms Thyroid function tests are usually normal A "cold" nodule is often seen on a technetium or radioiodine uptake scan of the thyroid Fine-needle aspiration biopsy of the nodule assists in the diagnosis

Hyperparathyroidism

is rare in childhood May be primary or secondary The most common cause of primary is parathyroid adenoma Familial may be an isolated disease, or it may be associated with MEN type 1, or rarely type 2A Chronic renal disease with impaired phosphate excretion is the most common secondary cause of THIS When ectopic PTH-related protein is present, calcium is elevated, serum PTH is suppressed, and serum PTH-related protein is elevated

Medical Child Abuse (Munchausen syndrome by proxy)

is the clinical scenario in which a caregiver seeks inappropriate and unnecessary medical care for a child The caregiver either simulates or creates the symptoms or signs of illness in a child Cases can be complicated and a detailed review of all medical documentation and a multidisciplinary approach is required Fatal cases have been reported. They may be actually ill or, more often, are reported to be ill and have a normal clinical appearance Among the most common reported presentations are recurrent apnea, dehydration from induced vomiting or diarrhea, sepsis when contaminants are injected into a child, change in mental status, fever, gastrointestinal bleeding, and seizures

Physical Neglect

is the failure to provide the necessary food, clothing, and shelter and a safe environment in which children can grow and develop Although often associated with poverty or ignorance, THIS involves a more serious problem than just lack of resources There is often a component of emotional neglect and either a failure or an inability, intentionally or otherwise, to recognize and respond to the needs of the child THIS—which must be differentiated from the deprivations of poverty—will be present even after adequate social services have been provided to families in need

Choking Prevention

is the fourth leading cause of death in children <5. The most common cause of THIS in children is food. Grapes are the #1 cause of food THIS death Never leave a small child unattended while eating. Children should sit up when eating. Children should not eat when riding in a car or playing. Cut foods into small pieces, remove seeds. Cook or steam vegetables. Become familiar with CPR Hazards list: Hot dogs, meat, sausage Fish with bones Popcorn, chips, pretzels Hard/sticky candy Grapes, raw vegetables Fruit with skins Seeds Dried fruits, nuts Peanut butter Ice cubes Cheese cubes Balloons, coins, marbles Small toy parts Pen or marker caps Button batteries Screws Jewelry Crayons, erasers, staples, safety pins, Stones Holiday decorations What anticipatory guidance is this?

Intussusception

is the most common cause of bowel obstruction in the first 2 years of life Invagination/telescoping of one segment of intestine into another segment Most commonly starts just proximal to the ileocecal valve and extends for varying distances into the colon Swelling, hemorrhage, incarceration, vascular compromise, and necrosis of the ileum may occur, as well as intestinal perforation and peritonitis Most frequent cause of intestinal obstruction in the first 2 years of life 3:1 male predominance In 85% of cases the cause is idiopathic The small bowel can occur in patients with CD and cystic fibrosis related to the bulk of stool in the terminal ileum *In children older than 6 years, lymphoma is the most common cause of this*

Chronic Lymphocytic Thyroiditis

is the most common cause of goiter and acquired hypothyroidism in childhood More common in girls, and the incidence peaks during puberty Caused by an autoimmune attack on the thyroid Presentation: The thyroid is characteristically enlarged, firm, freely movable, non-tender, and symmetrical, and may be nodular Occasionally patients note a sensation of tracheal compression or fullness, hoarseness, and dysphagia

Acute Appendicitis

is the most common indication for emergency abdominal surgery in childhood The incidence of perforation is high in childhood (40%), especially in children younger than 2 years, in whom pain is often poorly localized and symptoms nonspecific Clinical presentation: The typical patient has fever and periumbilical abdominal pain, which then localizes to the right lower quadrant with signs of peritoneal irritation The clinical picture is frequently atypical, especially in young children and infants Anorexia, vomiting, constipation, and diarrhea also occur Contrary to the vomiting of acute gastroenteritis which usually precedes abdominal pain, vomiting in appendicitis usually follows the onset of pain and is often bilious Serial examinations are critical in differentiating appendicitis from the many other conditions that transiently mimic its symptoms What is this?

Acetaminophen

is the most common pediatric poisoning and can produce severe hepatotoxicity Symptoms include: Nausea/vomiting Delayed jaundice-hepatic failure (72-96 hours) Toxicity most commonly results from repeated overdosage arising from confusion about the age-appropriate dose, use of multiple products that contain THIS, or use of adult suppositories metabolite may bind covalently to components of liver cells to produce necrosis

Surgery

is the most common treatment for primary hyperparathyroidism and provides a cure in about 95 percent of all cases

Coup injury

is the result of a sudden, violent stop that causes the brain to accelerate forward and hit the side of the skull What is this with PPE?

BP

is variable and depends on size and age. In some hospitals, four extremity blood pressures are taken by the nursery nurse as soon as the child comes to the nursery after delivery. In others, this is done if pulses are not equal in all extremities. What is this w/newborn PE?

Temperature

is very important and is taken rectally on arrival to the nursery. Newborn having temperature over 100.5 degrees (38 degrees C), should have a careful evaluation for infection. What is this w/newborn PE?

Prenatal testing

maternal age >35 years - previous child with structural or chromosomal abnormalities - parent with chromosomal or structural abnormalities - ethnic factors (African-Americans, Jews) - maternal disease state (diabetes, heart disease) - environmental exposure (including medications) - maternal infection (HIV, cytomegalovirus) What are these indications for?

MRI

may be helpful in understanding the full extent of cerebral injury, and occasionally neuroimaging results suggest specific etiologies Genetic and metabolic testing should be targeted based on history or THESE findings What is this dx eval with cerebral palsy?

Physical Abuse

may include abrasions, alopecia (from hair pulling), bites, bruises, burns, dental trauma, fractures, lacerations, ligature marks, or scars Injuries may be in multiple stages of healing Bruises are sometimes patterned (e.g., belt marks, looped cord marks, or grab or pinch marks) and are typically found over the soft tissue areas of the body Any unexplained bruise in an infant not developmentally mobile should be viewed with concern Lacerations of the frenulum or tongue and bruising of the lips may be associated with force feeding or blunt force trauma Pathognomonic burn patterns include: Stocking or glove distribution Immersion burns of the buttocks Branding burns such as with cigarettes or hot objects (e.g., grill, curling iron, or lighter) The absence of splash marks or a pattern consistent with spillage may be helpful in differentiating accidental from non-accidental scald The most common manifestations include: Bruises Burns Fractures Head trauma-first worst Abdominal injuries-second worst A small but significant number of unexpected pediatric deaths, particularly in infants and very young children (e.g., sudden unexpected infant death), are related to THIS What PE is this for?

Supportive therapy for shock and sepsis

mechanical ventilation, sedation and analgesia, renal replacement therapy for renal insufficiency, deep vein thrombosis prophylaxis, stress ulcer prophylaxis, nutrition and glucose control These are used for what in children?

Group A Beta Hemolytic Strep

most common bacterial etiology of pharyngitis; uncommon under age 3 yrs Symptoms/signs: fever, sore throat, abdominal pain; headache Exam: tonsillar erythema, exudate, swelling, cervical adenopathy-anterior, characteristic odor, palatal petechiae Culture is gold standard Rapid in office tests are specific but sensitive - dependent on good sample Complications include upper airway obstruction, peritonsillar abscess, acute rheumatic fever, and post strep glomerulonephritis (PSGN) Other: Group C and G β hemolytic 1-5% (don't cause rheumatic fever); diphtheria; N. gonorrhea

Congenital hypothyroidism

occurs in about 1:4000 infants Untreated, it causes severe neurocognitive impairment Most cases are sporadic resulting from hypoplasia or aplasia of the thyroid gland or failure of the gland to migrate to its normal anatomic location Another cause of congenital is dyshormonogenesis due to enzymatic defects in thyroid hormone synthesis Affects approximately 1 in 30,000 live births Isolated secondary or tertiary is rare T4 is low to normal Must assess other pituitary hormones Occurs 1:100,000 live births What etiology is this in babies?

Diffuse Axonal Injuries

occurs in about half of all severe head traumas, making it one of the most common traumatic brain injuries is more widespread than focal injuries and typically more devastating Severe is one of the leading causes of death in people with traumatic brain injury The main symptom is lack of consciousness, which can last up to six hours or more. A person with a mild or moderate who is conscious may also show other signs of brain damage, depending upon which area of the brain is most affected Given severity of injury and usual extended loss of consciousness patient typically require imaging Magnetic Resonance Imaging (MRI) - This is the preferred test CT Scan - CT scans may result in false negatives Evoked Potentials - Evaluate the visual, auditory, and sensory pathways in the brain Electroencephalogram (EEG) Immediately reduce brain swelling. IV steroids, consider intubation Once stabilized, patients require multidisciplinary rehabilitation Speech therapy Physical therapy Occupational therapy Recreational therapy Adaptive equipment training Counseling What is this?

Respiratory Distress Syndrome (RDS)

occurs in the United States in 14% of low birth weight infants. The incidence INCREASES with DECREASING gestational age. Risk factors: Male gender -Second-born of twins -Family history of RDS -Maternal diabetes -Birth by Cesarean section without maternal labor -Has been reported in all races, but it occurs more often in Caucasians Pathophys: Surfactant deficiency: DECREASED lung compliance DECREASED functional residual capacity INCREASED dead space Ventilation-perfusion mismatch Right-to-left shunt involving as much as 80% of the cardiac output Hyaline membranes that line the alveoli form within one hour after birth. Within 36-72 hours, surfactant begin to be produced in these membranes in term newborns. Since this synthesis is very complex, premature or ill infants may not produce the right amount of surfactant. What is this?

Poisoning

occurs when exposure to a substance adversely affects the function of any system within an organism account for more than 130,000 visits to emergency departments In children 1-5, associated with unintentional ingestions In older children, associated with suicide attempts or experimentation with drugs Accounts for 1% of all Pediatric hospitalizations per year Most occur in the home (92%) Fatal ingestion occur at 0.01% rate 86% of ER visits due to THIS relate to ingestion of adult medications, with a majority of those from grandparents medications What is this epi for?

Fever

occurs when there is a rise in the hypothalamic set point in response to endogenously produced pyrogens (IL6, tumor necrosis alpha, IO4) The majority of THIS in pediatric patients are caused by self-limiting viral infections Is not a disease Teething typically does not cause THIS over 38.4°C (101.1F) What pathophys is this?

Contrecoup Injury

on the other hand, occurs when the brain accelerates forward, hits the side of the skull, and then bounces off the other side of the skull What is this with PPE?

Juvenile hypothyroidism

particularly if goiter is present, is usually a result of chronic lymphocytic (Hashimoto) thyroiditis Presents with: Short stature Abnormal weight gain Delayed epiphyseal development/fontanel closure Retarded dental eruption Skin may be dry, thick, scaly, coarse, pale, cool, or mottled, or have a yellowish tinge Hypotonia Slow relaxation component of deep tendon reflexes Non-pitting myxedema Puberty may be delayed Metromenorrhagia may occur in older girls What is this?

Catarrhal

presents like the common cold. Most contagious stage. What stage is this with pertussis?

Respiratory rate

ranges from 30-60 breaths per min What is this w/newborn PE?

Postneonatal mortality

refers to infant deaths during the period of 1 to 12 months Primarily due to: Infection Malnutrition Dehydration

Hirschsprung Disease: Congenital Aganglionic Megacolon

results from an absence of ganglion cells in the mucosal and muscular layers of the colon, resulting in failure of the colonic muscles to relax in front of an advancing bolus The aganglionic segment has normal or slightly narrowed caliber with dilation of the normal colon proximal to the obstructing aganglionic segment The mucosa of the dilated colonic segment may become thin and inflamed, causing diarrhea, bleeding, and protein loss (enterocolitis) Clinical presentation: Failure of the newborn to pass meconium, followed by vomiting, abdominal distention, and reluctance to feed, suggests the diagnosis of THIS *Most children with THIS do not pass stool in the first 24 hours of their life* Enterocolitis manifested by fever, explosive diarrhea, and prostration is reported in approximately 50% of affected newborns May lead to inflammatory and ischemic changes in the colon, with perforation and sepsis Later infancy reports alternating obstipation and diarrhea The older child is more likely to have constipation alone The stools can be foul-smelling and ribbon-like The abdomen is distended with prominent veins, with peristaltic waves visible On digital rectal examination, the anal canal and rectum are devoid of fecal material despite obvious retained stool on abdominal examination or radiographs What is this?

Oral Rehydration Therapy (ORT)

should be the first-line treatment for most children with acute gastroenteritis Children with mild to moderate dehydration are candidates for THIS The physiologic effectiveness of THIS is based on the coupled transport of sodium and glucose molecules Frequent small aliquots (5-15 mL) should be given to provide approximately 50 mL/kg over 4 hours for mild dehydration and up to 100 mL/kg over 6 hours for moderate dehydration Commercially available solutions provide 45-75 mEq/L of Na+, 20-25 mEq/L of K+, 30-34 mEq/L of citrate or bicarbonate, and 2%-2.5% of glucose is contraindicated: In children with altered levels of consciousness or respiratory distress who cannot drink freely In children suspected of having an acute surgical abdomen In infants with greater than 10% volume depletion In children with hemodynamic instability In the setting of severe hyponatremia ([Na+] < 120 mEq/L) or hypernatremia ([Na+] > 160 mEq/L) Failure of oral rehydration due to persistent vomiting or inability to keep up with losses mandates intravenous therapy

Pansinusitis

spread of purulent infection to other "spaces" ipsilateral and contralateral sinuses, retro-orbital space, intracranial. What is this?

SIDS

supine sleeping position appropriate bedding (avoid polystyrene and soft cushions) good prenatal care and nutrition home monitors for infants with increased risk factors improve services to and identify high risk mothers prevention of maternal cigarette smoking These decrease the risk factors for what?

Varicella Zoster Virus

symptoms include: Skin scarring Limb hypoplasia Chorioretinitis Microcephaly WHAT infection can be fatal for the infant of a mother who develops THIS 5 days before or 2 days after delivery Other symptoms include: Severe rash Pneumonia Hepatitis What maternal infection is this?

Ross

taking the patient's own pulmonary valve and putting it in the aortic valve position and then using a pulmonary allograft (cadaver) to replace patients pulmonary valve. What procedure is this with aortic stenosis surgical repair?

Late adolescence

the young person generally becomes less self-centered and more caring of others Social relationships shift from the peer group to the individual Dating becomes much more intimate. By 10th grade, 40.9% of adolescents (41.9% of males and 39.6% of females) have had sexual intercourse, and by 12th grade, this has increased to 62.3% (59.6% of males and 65% of females) Abstract thinking allows them to think more realistically about their plans for the future This is a period of idealism; have rigid concepts of what is right or wrong

Sudden Infant death Syndrome (SIDS)

unexpected and unexplained death of infant under 1 year of age peak incidence 2-4 mo; rare prior to 4 wks of age and after 6mo leading cause of death in infants 1mo-1yo cause unknown Rates higher during the winter months Risk factors suggest correlation between fetal hypoxemia and poor prenatal care Maternal - smoking, drug use, poor prenatal care, low education level, single mom, young maternal age < 20yo, STD Neonatal - cyanosis, fever, hypothermia, irritability, poor feeding, respiratory distress, tachycardia, tachypnea, apnea of prematurity, bradycardia, prone sleep position Newborn - low birth weight, male, prematurity, small for gestational age, lack of breast feeding, prone sleep position Socioeconomic - crowded home, poor living conditions, multiple child death in family (no cause found), poor finances What is this?

Hyperthyroid

β-Adrenergic blocking agents These agents are adjuncts to therapy β1-Specific agents such as atenolol are preferred Rapidly ameliorate symptoms such as: Nervousness Tremor Palpitations Iodide Recommended only for acute management of severely thyrotoxic patients Antithyroid agents: Methimazole, PTU Interfere with thyroid hormone synthesis Adequate control is usually achieved within a few months Initial dosage Methimazole is initiated at a dose of 10-60 mg/d (0.5-1 mg/kg/d) given once a day Initial dosing is continued until FT4 or T4 have normalized and signs and symptoms have subsided What tx is this for?