When is a strong Moro (startle) reflex considered abnormal? What is it indicative of?
6 months and older is indicative of brain damage
What are white papules found on the gum line that resembles erupting tooth?
Epstein’s Pearls
Urethral opening on top of the penis gland/shaft?
Episoadias (refer)
Asymmetry of the thigh/gluteal folds should make you rule out what?
Rule out congenital Hip dysphasia or hip fracture
If mother is HBsAG positive what should you give the neonate?
HBIG (Hep B immunoglobulin) & Hep B Vaccine
DTap is given to what ages?
< 7
Name that test: Hold each knee and place your middle finger over the greater trochanter and rotate hips in frog leg position. A click/clunk indicates a positive test.
Ortolani Maneuver
Name that test: Place index & middle finger over the greater trochanter and push both knees midline. Positive finding will produce a clunk and suggests developmental dysphasia of the hip.
Barlow Maneuver
If the infant is making clicking noises while breastfeeding what does it mean and what should you do?
Poor latch, more of the areola needs to go in mouth
A pediatric patient has a hyperextended neck and is mouth breathing, what should you suspect?
Epiglottitis (Haemophilus is main cause prior to Hib vaccine)
Asymptomatic Abdominal mass that rarely crosses to midline in patients 2-3 years old is known as what?
Wilm’s Tumor (Congenital Kidney Tumor)
At what age should a child roll both directions, play peak-a-boo & pat-a-cake?
9 months
At what age should speech be understood by most family members?
2
At what age should speech be understood by strangers?
3
What age can a child ride a tricycle?
3
What age should a child be able to copy a circle?
3
What is the age & the name of the stage where the child expresses the desire to marry the opposite sex?
Oedipal Stage, occurs between 3-6 years old
What age should a child be able to ride a bicycle?
6-7 years
ADHD is accompanied by what 3 symptoms?
Hyperactivity
Impulsivity
Inattention
ADHD DSM-5 Diagnostic Criteria
Symptoms present before age 12
Symptoms > 6 months
Symptoms evident in 2 different settings
At what age can you prescribe meds for ADD?
What schedule drugs do you prescribe?
6
Schedule 2
Initial daily Med management for persistent asthma in a 4 year old?
Inhaled Steroid
What is the one major difference in asthma management in pediatrics?
Oral Leukotryine Agonist (singular) because 1/3rd of Peds have LTR driven asthma
Inhaled steroids in children can affect their height, therefore what is the tolerance level of asthma attacks in one year before placing a child on steroids every day?
4
Most common bacteria causing pneumonia?
Tx?
Streptococcus Pneumonia
90mg/kg per day of Amoxicillin
Most sensitive symptom of confirmed pneumonia?
Increased RR
Most common cause of bronchiolitis?
RSV
When do you use albuterol/steroids in bronchiolitis?
Only in severe bronchiolitis because it can be treated symptomatically with Tylenol & it is viral so ABX are not indicated
What is the most common symptom in patients with cystic fibrosis?
Cough
(Often diagnosed at birth through screening)
Most common form of cancer in Peds?
Leukemia (ALL)
Most evident sign on a CBC that signifies Leukemia?
Thrombocytopenia accompanied by a Low platelet count - <100,000
(Bleeding!!! -bruising, gums bleeding)
Any node > ____ mm is considered enlarged (except Epitrochlesr node)
10
Red Flag Headache symptoms in child?
-Night time awakening from head ache
-Thunderclap HA
-N/V
-Age <3
-absent family history
What is a classic finding in a patient with pyloric Stenosis?
4-6 week old baby with an OLIVE SHAPED mass
Work Up - Ultrasound
More common in first born male
GERD management in Peds?
-avoid Smoke
-Breastfeed
-small frequent thickened feeds
Do not start H2 Blockers/PPI if possible
Intermittent colicky abdominal pain, that’s accompanied by blood mucous current jelly stools is caused by?
Intussusception
Preferred means of rehydration in someone with viral gastroenteritis?
Commercially Prepared Electrolyte Solution
When should the male testicles be descended that warrants referral if they haven’t?
6 months
At what age is hydrocele expected to resolve?
By 12 months
What is often associated with hydrocele?
Inguinal Hernia
Bilateral conjunctivitis without exudate, and the patient presents with raised red papillae on tongue (strawberry tongue). Swollen hands/feet. What is this presentation found in?
Kawasaki Disease
(Follow-up with Ped Cardiologist)
A pull or twist of the arm may cause what?
Nursemaid’s Elbow (annular ligament slips over radial head)
What does Oshood Schlatter Disease usually correspond with?
Growth spurt (9-14 yo) because the soft and hard tissue haven’t grown at equal rates
Pain over the tibial tubercle/knee in adolescents is associated with what?
Osgood Schlatter Disease
Positive Trendelengberg’s sign? Indicative of what?
Ask child to stand on affected side causes pelvic tilt (unaffected side lower) -A DIP IN THE HIP!
Leg Calve-Perthes Disease & Slipped Capital Fenoral Epiphysis
Osteonecrosis of the capital femoral epiphysis, more common in boys, walk with a limp.
Legg-Calve-Perthes Disease
Patient has history of febrile illness and aspirin/salicylate inake is at risk for what?
Aspirin
Child sensitive to noises, touch, smells, and/or textures. Poor eye contact. Does not interact with others. Slow to poor language development. Repeated body movements such as flapping arms. May show normal development but regress by age 1-2. What is this disease known as?
Autism
Acute onset of fever, sore throat, headache, and anorexia. Multiples blisters on hands/feed/diaper area. Ulcers inside mouth and throat. What disease is this known as?
Hand Foot Mouth
Self-limited Disease recovery will occur 5-7 days
Ibuprofen/Tylenol
Salt Water gargle & drink cold fluids
Koplik’s spots are small white papules insides the cheeks by the rear molars. What are common in?
Measles
Smooth wax-like round (dome shaped) papules 5 mm in size. Central umbilication with white plug. Name that rash?
Molluscum Contagiosum
Name that rash: generalized rash in different stages where new lesions appear daily in form of papules, vesicles, pustules, & crusts. Purification & highly contagious.
Varicella
Name that rash: Located in the interdigital webs of hands, waist, axilla, penis. Very puritic, especially at night.
Scabies
Name that rash: Homey colored crusted lesions. Fragile bullae. Pruritic.
Impetigo
Patient is mentally retarded with large head circumference. Patient has a long face with prominent forehead, jaw, & large ears. Large body with flat feet. What is the name of the disease?
Fragile X Syndrome
What causes Molluscum Contagiousum?
Poxyvirus
At what age do children develop early abstract thinking (Piaget)?
11
What age can the first HPV (Gardasil) vaccine be given?
9
All college freshman living in dorms are at high risk for what? What is indicated?
High Risk of meningocccal infection - MCV4 is recommended by CDC
Live attenuated influenza virus nasal only is indicated for what age groups?
Healthy people aged 2-49 years of age
Vaccine Adverse Event Reporting System is responsible for what?
Governmental program to report clinically adverse events
What laboratory test may be elevated in teens going through growth spurts?
Alkaline Phosphate
No parental/guardian consent is necessary for what?
Contraception
Treatment of STDs
Diagnosis/Management of Pregnancy
Name that Tanner Stage: Breast Bud Development
II
Name that Tanner Stage: Breast/Aerola are in one Mound
III
Name that Tanner Stage: Aerola/Breast separate to form secondary mound
IV
Name that Tanner Stage: testes enlarge - Increased scrotum Rugae
II
Name that Tanner Stage: Penis Lengthens
III
Name that Tanner Stage: Penis Widens
IV
Name that Tanner Stage: Adult like
V
What are 2 examples of an emancipated minor?
-Legally Married or Active Duty Military
(Give full consent as an adult w/o parental involvement)
What type of birth control should be avoided in anorexic patients?
Depo-Provera & other progesterone only contraceptives since they can cause bone loss
Adam’s Forward Bend Test helps diagnose what?
Scoliosis - refer to pediatric orthopedic specialist
What degree curve in scoliosis diagnoses does not need to be referred and can be observed?
10 degree curve and less
Primary/Secondary Amenorrhea: absence of menarche by age 15
Primary
Primary/Secondary Amenorrhea: Absence of menses for 3 cycles last 6 months and previously had menses. Can be caused from pregnancy, stress, exercise, or PCOS.
Secondary
More common in obese males where bilateral breast are enlarged due to fatty tissue. Soft to touch & non tender. What is this caused by?
Pseudogynecomastia
Occurs in pubertal males who having the onset of enlarged breast/assymetrical breast tissue. Breast are tender to palpitation. What is this caused by?
Gynecomastia
True/False: Any treatment not related to sexual activity requires parental consent.
True
A child has an enterobiasis infection, what is this and what should you do?
Pinworms - scotch tape test
Orchitis (swelling of testicles) is caused by what virus?
Mumps Virus
Precocious puberty is defined as puberty before the start of what age in boys/girls?
Girls 8
Boys 9
A lacy, slapped cheeked appearing rash that appears in 3 stages is caused by what condition?
