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What day does treatment need to be started by for Kawasaki's disease?
10th day! (gamma globulins and aspirin)
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Why do we give aspirin in Kawasaki's disease?
prevent clots and for anti-inflammatory
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How long does the child with Kawasaki's disease need to wait to receive live vaccinations after IV gamma globulin?
5 months
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What type of genetic disorder is neurofibromatosis?
Autosomal dominant- 50% chance of passing it on
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How long does the 5% permethrin lotion (Elimite) have to be left on in the treatment of scabies?
8 to 14 hours
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When does axillary hair form in relation to pubic hair?
axillary hair 2 years after pubic hair
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In what tanner stage does menarche (first period) begin?
stage 3-4
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Developing through tanner stages 2 to 5 takes about how many years?
3 years
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In what tanner stage does the growth spurt occur?
Tanner stage 3
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Ejaculation occurs as boys approach tanner stage ___
3
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Gynecomastia is a normal variant due to estrogen/testosterone imbalance, occuring in which of the tanner stages?
Tanner II to III
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What needs to be taken into consideration with the medicaitons Wellbutrin (Zyban) and Chantix?
- Not approved for use in < 18 years of age- Risk of suicide.
- Can cause seizures in people with a prior hx of anorexia nervosa or builimia
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What pharmacologic method can be used to treat Enuresis/encopresis and what consideration is necessary with this medication?
DDADP (Desmopressin)- after the age of 8.
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What is the incubation period of lice?
6-10 days
-
What is the incubation period of scabies?
4-6 weeks
-
What is the treatment for scabies?
5% permethrin lotion (elimite)- leave in places 8-14 hours
-
which neurocutaneous syndrome is characterized by multiple cafe-au-lait spots on the body?
neurofibromatosis (more than 6 cafe au lait spots= hallmark)
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Which medication makes you more prone to seizures?
Wellbutrin
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Which seizure is characterized by "drop attacks"?
- Atonic seizures
- - do not lose consiousness, lose all muscle control and drops straight to the ground
-
Which seizure is characterized by sudden "jumps"?
Myoclonic seizures
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Why are seizure meds not given with anti-fungals?
Inhibits (break it down stronger) the liver and level becomes higher- side effect is respiratory depression- can easily quit breathing
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Which seizure medication is indicated for infants and really young children, as well as status epilepticus?
Phenobarbital
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What 2 drugs cannot be given with Valporic acid (Depakene)?
Klonopin and Rifampin
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Which type of seizure is characterized by automatism's (lip smacking, blinking, pacing back and forth), somatosensory disturbances (flushed feeling, heart racing, hearing noises), and you are able to lead them around and take them to safe environment (sit them down)?
Complex partial seizure
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Which seizure is seen in the shcool aged child, brief staring events lasting 5-15 seconds, and will outgrow by age 20?
Absence seizures (petit mal)
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Which seizure has phases (aura, tonic, clonic, and postictal), and is characterized by loss of consiousness and will have loss of bowel and bladder control?
Tonic clonic (grand mal) seizure
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when do adolescent girls and boys go through their growth spurts?
- Girls: 10-12 years
- Boys: 12-14 years
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What specific nutritional needs do adolescents need? Name some food examples
- Calcium and Iron
- Calcium: milk, shakes, green leafy veggies, broccoli, cheese, yogurt
- Iron: Red meat, green veggies, raisins, peanuts, fortified cereals
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In girls, what tanner stage does breast buds appear?
2
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In tanner stage ___, the testes become larger, scrotum becomes larger, somewhat reddened, and altered in texture.
2
-
In what tanner stage does the penis begin to enlarge?
3
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Delayed menarche is menarche occuring after which age?
17.
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The increase in the size of testes is the first reliable sign, which occurs between which ages?
9-13 years
-
How do you tell if it is testicular torsion or an STD?
Lift testicles up- if it is an std- lifting up helps the pain, if testicular torsion- will cause SEVERE pain when you lift up testes
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When you lift testis and it does not help, this is called the ______.
Phren's sign
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How many hours do you have to correct testicular torsion?
4-6 hours... it is a surgical emergency!!!
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What needs to be done when a boy presents with gynecomastia?
Palpate the testis- testicular tumor
-
Which ADD medication is associated with suicide?
strattera
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What is the primary cause of enuresis/encopresis?
Genetics!
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________: abnormal accumulation of fat in the liver and other ograns of the body, severe increase of pressure in the brain.
Reye's syndrome
-
What symptoms are present in stage I of Reye's syndrome?
Persistent or continuous vomiting, listlessness, drowsiness, loss of pep and energy
-
What are some common OTC meds associated with Reye's syndrome (contain salicylates)?
-
How are migraine or cluster headaches described?
Entire head
-
How are tension (stress) headaches described?
Band across head
-
How do you know if illness is too much for the child?
How many days of school they are missing- 2 to 3 days a month is too much
-
Headache is usually accompanied by nausea and is relieved with vomiting if _______.
brain tumor
-
What is the cause of rheumatic fever?
Group A strep
-
_____ (macular, nonpruritic rash on trunk and proximal limbs... never on face) is seen with which disease?
Erythema marginatum------ rheumatic fever
-
What is the treatment for Rheumatic fever?
Penicillin G injection monthly, or PO 3x a day
-
What are the symptoms associated with Kawasaki disease?
- Diarrhea, vomiting, abdominal pain
- Irritability
- Fever > 5 days
- RED: eyes, tongue, throat, hands, feet
- Rash
- Swollen nodes
- Fast/ & or irregular pulse
-
What is the diagnositc material for kawasaki disease?
- 5 or 6 major findings
- - Fever for 5 or more days (unresponsive to antibiotics)
- - Bilateral conjunctivitis no exudation
- - Erythema of oral mucosa (strawberry tongue)
- - Peripheral edema and erythema (desquamation of palms and soles)
- - Polymorphous rash
- - Cervical lymphadenopathy (palpate neck)
-
What is the treatment for Kawasaki disease?
- IV gamma globulin within 10 days of onset
- High dose aspirin until afebrile then reduced dose (may be indefinitely given)
- Preventative measure- flu shot- delay Live vaccines for 5 months after IV gamma globulin
- May need activity restrictions
-
Which infections are linked to an increased risk of developing lymphoma? (4)
- HIV
- Epstein-Barr virus (MONO)
- H. pylori
- Hepatitis B or C
-
Who should you think of when you think of appendicitis?
12 year old boy
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Manifestions of ____ include: vague, midline, constant pain for several hours then localizes to the RLQ
Appendicitis
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With which disease will there be rebound tenderness at Mcburney's point and the obturator sign (rotating thigh) is present?
Appendicitis
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People with neurofibromatosis have a _____ chance of transmission to each offspring
50% (autosomal dominant)
-
What are the two peaks in ages seen with JRA?
- 1-3 years (young kids)
- 9-14 years (School age)
-
What is the treatment for JRA?
- NSAIDS (may end up on long-term aspirin)
- Methotrexate
- Steroids
- PT/OT
- Opthamology (Uveitis is common)
-
Uveitis is commonly associated to which disease?
Juvenile Rheumatoid Arthritis (JRA)
-
With what 3 diseases will you see spots on the hands and feet?
- Rocky mountain spotted fever
- Kawasaki disease
- Syphillis
-
What is the hallmark sign of lyme disease?
- Bulls eye right in the center
- Swollen lymph nodes (hallmark)
-
What is the treatment regimen for Lyme disease?
- Try amoxicillin first- if not getting better-
- Tocycline- (belongs to tetracyclines)- not supposed to be given if <8 years old
-
Pruritis that is worse at night is common to which disease?
Scabies
-
What do you need to teach parent of child who has scabies?
- Treat entire household!!!
- Leave medicine on 8-14 hours
-
SEVERE abdominal pain is seen with which spider bite?
Black widow
-
Eschar at the bite site followed by necrosis and skin sloughing is characteristic to which spider bite?
Brown recluse
-
What is the home treatment for a spider bite?
- Clean the site well with soap and water
- Cool compress over the bite location and elevate
- Acetaminophen
-
What is the treatment for a black widow bite?
Anti-venom medication
-
What is the treatment for a brown recluse bite?
Corticosteroids
-
What is considered a major burn?
>10% superficial and >2% partial or full
-
What sites are seen as major burns regardless of extent in kids?
Hand, feet, face, eyes, ears, perineal
-
What teaching is needed for Bee stings?
- Do NOT pick or pull on stinger
- Scrape stinger out
- Apply ice or cold packs immediately (apply warmth later)
-
What is the first sign/symptom of anaphylactic reaction?
Palms or side of the feet itch
-
Which medication lowers the seizure threshold?
Wellbutrin
-
As many as 100 individual, 3-7 months old, impossible to stop, phenobarbital is given a lot for these children.
Infantile spasms (west syndrome)
-
Bad prognosis, 2-6 years old, severe leading to mental retardation and behavior problems, every time they have a seizure- a little part of them dies
Lennox- Gastaut syndrome
-
What is a concern with a teen girl on seizure meds and birth control?
Cause liver to induce and break birth control down faster and not in the body anymore- pregnancy can occur
-
What is the therapeutic level for tegretol (carbamazepine)?
4-12
-
Which seizure has a consiousness variation, but not a total loss in consciousness- you are able to lead them around and take them to a safe environment
Complex- partial seizure
-
What is a ketogenic diet?
High fat/ low carbs
-
Girls more than boys
Ages 4-8 or 9 (school age children)
Child unaware of episode, brief staring events
Absence seizures (petit mal)
-
Lose consciousness
Phases: aura, tonic, clonic, postictal
Bite tongue/ bladder incontinence
Tonic-clonic (grand mal)
-
Who is tegretal (carbamazepine) given to?
Any type of seizure- all types not specific type
-
Who is phenobarbital given to?
- Infants and very young children with seizures
- *Great status epilepticus*
-
What is the side effect of phenobarbital?
Respiratory depression!!!- major!!
-
What is a side effect of Valporic acid (Depakote)?
Initially makes them not hungry, then insatiably hungry- will sometimes gain 30 pounds
-
What can valporic acid (depakote) not be given with?
Klonopin and rifampin!
-
What is a side effect of Ativan (lorazepam)?
Very drowsy and respiratory problems!!
-
What are 2 emergency meds for seizures?
Valium and Ativan
-
what is the goal of treatment for Reye's syndrome?
Maintain effective cerebral perfusion and control increasing ICP
-
Headaches can be related to _____ and triggered by that
GERD
-
What is though to cause kawasaki's disease?
viral infectious agent
-
What is the leading cause of acquired coronary artery disease in children?
Kawasaki's disease
-
What are two lethal associations with Reye's syndrome?
- Abnormal accumulation of fat in liver and other organs of the body
- Severe increase of pressure in the brain
-
Which seizure med can be given rectally during an emergency?
Valium (diazepam)
-
What are warning signs we worry about during a seizure?
- Anascoria (uneven pupils)
- Signs of increased ICP: early- vomiting, late- fixed & dilated pupils
- Focal deficits
- Unusual physical findings: sunsetting eyes, low set ears, high palate, holding hand in tight position- Edwar'ds, weird shaped feet
- Change in seizure pattern: meds (growth- kids need more meds as they grow), tumor increase in size
-
What is the primary cause of encopresis?
Constipation
-
What is the main treatment for Reye's syndrome?
Decrease cerebral edema
-
What medicine is given for status epilepticus rectally?
Diazepam (Valium)!!
-
What should not be given with seizure medications?
anti-fungals!!
-
What is a common side effect of seizure medications?
Respiratory depression!!!
-
What is the major risk factor for lymphomas?
Mono (epsetin barr virus)
-
Where is scabies most often seen?
In the folds of the skin, gluteal folds, webbing of fingers
-
What is the treatment for scabies?
- Elimite (permethrin)- it is a pesticide
- 8 to 14 hours
-
What is the main concern with epidemics?
Universal precautions!!!! If airborne- mask added to universal precautions
-
What is the drug of choice for lyme disease? What do we worry about while giving this drug?
- Doxcylcline
- - If less than 8 years old- will stain teeth!!!
-
How much do boys and girls grow typically during the growth spurt (2 yr growth spurt)?
- Boys- 4 inches/ year
- Girls- 3 inches/ year
-
What diagnostic material is related to ADD?
Must have had an onset before age 7 years, lasting longer than 6 months
-
A common physical finding with Rheumatic fever is what? (2 things)
- Previous illness of strep
- A new murmur!!
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