peds exam 1

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peds exam 1
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  1. When do you start bagged valve mouth on a neonatal
    Heart rate below 100 beats per minute, gasping or apnea
  2. What do you do when a neonatal heart rate is below 60 beats per minute
    Chest compression
  3. When would you give IV epinephrine for a neonatal
    When chest compression does not increase the heart rate greater than 60
  4. If meconium aspiration is present in a neonatal delivery what can you assume
    Signs of fetal stress
  5. If there is a coarctation within the neonate what will be affected
    Right upper extremity
  6. What is the dosage for an IV fluid Bolus
    10 cc/kg normal saline or LR
  7. How often is the APGAR performed
    perform at 1 and 5 minutes

    also perform at 10 min 5 min is depressed (<6)
  8. what gives you the true measurement of gestational age
    ballard (dubowitz) score
  9. weight <10%ile for age is known as what
    small for gestational age
  10. >90%ile for age is known as what and why is this a concern
    • large for gestational age
    • concern for neonatal hypoglycemia
  11. what type of baby would you see a drop in sugar levels
    • big baby
    • tiny baby
    • septic baby
  12. what are the normal vital signs for a neonate
    • HR 120-160
    • Res 30-60 (if >60 may be only sign if baby is septic)
    • temp <100.4
    • BP 70/50
  13. if a neonate has an enlarged anterior fontanel, what is the problem
    hypothyroidism
  14. what can be occurring with closed fontanels
    craniosynostosis
  15. if there are cysts anterior midline what do you want to consider
    thyroid disorder
  16. if there are cysts or bulges anterior to the SCM what do you want to consider
    branchial cleft cysts
  17. if there are cysts or bulges posterior to the SCM what do you want to consider
    cystic hygroma
  18. if the neonate has a scaphoid shaped abd what do you want to consider
    diaphragmatic hernia
  19. which test is when there is a clunk when the hip relocates anteriorly
    ortalani
  20. which test is when there is a click when the hip dislocates posteriorly
    barlow
  21. if there is an elevated pulse pressure what do you want to consider
    PDA
  22. if there is a decrease in pulse pressure what do you want to consider
    coarctation of the aorta
  23. if there is asymmetry of the transverse gluteal crease what could be the cause
    congenital dislocation of the hip
  24. which type of skin will be present on a near term baby
    vernix caseosa
  25. what will be on the skin of a preterm baby
    lanugo
  26. the rooting reflex should be gone by when
    4-6 months
  27. when should the fence reflex be gone
    4 months
  28. when should the moro reflex be gone
    4-6 months
  29. when should the grasp reflex be gone
    4 months
  30. what can give an indication as to any developmental stresses
    placenta
  31. this type of head swelling is the most common, crosses suture lines and can resolve in days
    caput succedaneum
  32. which type of head swelling is less common, does not cross suture lines and resolves in weeks to months (can lead to jaundice)
    cephalohematoma
  33. which type of head swelling is rare, does cross suture lines, pushes the ears anteriorly, and treatment is compression and resuscitation
    subgaleal hemorrhage
  34. when should the eyes of a newborn be aligned
    4 months
  35. benign tiny bumps of the gingiva/gums of newborns are known as what and when do they go away
    • Epstein pearls
    • 1-2 weeks
  36. when do umbilical hernias in a newborn resolve
    5-6 years
  37. medial deviation of the mid and forefoot is known as what
    metatarsus adductus
  38. which gross motor skill should be present at week 2
    symmetric movements
  39. which gross motor skills should be present at 2 months
    • lifts head on prone
    • grasps
  40. which gross motor skill should be present at age 4 months
    • no head lag on pull up
    • rolls over (front to back)
  41. which gross motor skill should be present at age 6 months
    sit independently (tripod)
  42. which gross motor skill should be present at 9 months
    pulls to stand
  43. which gross motor skill should be present at 12 months
    walk
  44. which gross motor skill should be present at 18 months
    • run
    • 1-2 stairs
  45. which fine motor skill should be present at 2 weeks
    equal movements
  46. which fine movement skills should be present at 2 months
    fixes (follows OD and OS)
  47. which fine motor skill should be present at 4 months
    raking
  48. which fine motor skill should be present at 6 months
    hand-hand transfers
  49. which fine motor skill should be present at 9 months
    inferior pincer grip
  50. which fine motor skill should be present at 12 months
    fine pincer grip
  51. which fine motor skills should be present at 18 months
    • drinks from cup
    • tower of 4 cubes
  52. which fine motor skills should be present at 24 months
    • pours cup
    • tower of 6 cubes
  53. which language skills should be present at week 2
    responds to noise
  54. which language skill should be present at 2 months
    vowel sounds (coos)
  55. which language skills should be present at 4 months
    • guttural sounds
    • looks to sound
  56. which language skills should be present at 6 months
    • babbles
    • turns to sound
  57. which language skills should be present at 9 months
    • first word
    • associates meaning of commands
  58. which language skills should be present at 12 months
    2-5 words
  59. which language skills should be present at 18 months
    • >6 words
    • follows commands
  60. which language skills should be present at 24 months
    2 word phrases (want that)
  61. what cognitive/social skills should be present at 2 weeks
    tempermental
  62. what cognitive/social skills should be present at 2 months
    social smile
  63. what cognitive skills should be present at 4 months
    • laugh aloud
    • prefers mom
  64. what cognitive/social skills should be present at 6 months
    imitates speech
  65. what cognitive/social skills should be present at 9 months
    • peek-a-boo
    • stranger anxiety
    • object permanence
  66. what cognitive/social skills should be present at 12 months
    plays interactively
  67. what cognitive/social skills should be present at 24 months
    parallel play
  68. what could be a reason why a baby rolls over prior to 3 months
    increased tone
  69. what may be the issue if there is poor head control at 5 months
    hypotonia
  70. what could be the cause if there is a lack of sitting at 7 months
    hypotonia
  71. what could be the issue if there is hand dominance before 18 months
    contra-lateral neuro-motor abnormalities
  72. what may be the issue if no true words/gestures are made by 15 months
    check the hearing
  73. when should infants be screened for anemia
    between 6-12 months
  74. when should children be screened for lead
    1-2 y/o if high risk
  75. how long should children be in a rear-facing car seat
    2 years or until they reach the seats ht or wt limit
  76. how long should a child be in a booster seat
    until 4'9 (usually 8-12)
  77. under what age should children be in the back seat
    age 13
  78. when should babies be started on solid foods
    4-6 months (rice cereal)
  79. when can cow's milk be introduced to a baby
    12 months (due to gi bleeding and anemia)
  80. when can a baby be introduced to honey or canned foods
    12 months (infant botulism)
  81. what is the recommended water temperature for babies
    keep hot water heater to 120 degrees
  82. when does the lower central incisor followed by the upper central incisor usually erupt
    ~6 months
  83. what should be checked if there is a disruption in the eruption of teeth
    TSH and Ca++
  84. when do permanent teeth start to begin to erupt
    ~6-8 years and ends ~12 yrs
  85. what is the tx for thrush
    • oral nystatin (not absorbed systemically)
    • OR
    • gentian violet (will kill everything) will stain skin and tx mothers nipples if breastfeeding
  86. what is the tx for diaper rash
    lotrimin (candida affects scrotum while tinea doesnt)
  87. what is the definition of failure to thrive
    • weight < 5th percentile, a fall in weight across two major percentile lines
    • no growth for 2 months (<6 mo's)
    • no growth for 3 months (>6 mo's)
  88. what is the cause of FTT
    the cause is always insufficient usable nutrition at the cellular level (not always due to inadequate intake)
  89. what is type 1 FTT
    weight is low, height and HC is preserved

    *caused by malnutrition, malabsorption
  90. what is type II FTT
    weight and height low, HC preserved

    * caused by dwarfism, endocrine d/o
  91. what is FTT type III
    weight, height, HC low

    * causes are prenatal injury/infection
  92. if a baby/child is admitted and feeds fine and gains weight while in the hospital, what could be the reason for FTT
    poor feedings at home
  93. if a baby/child is admitted and feeds fine but doesn't gain weight, what could be the reason for FTT
    malabsorption, endocrine d/o, metabolic dz
  94. what is the tx for FTT
    increase intake to 150% basal rate
  95. what is the most common cause of congenital syndromes
    multifactoral defects
  96. which congenital syndrome is associated with 3 copies of chromosome 21
    trisomy 21 (down syndrome)
  97. what is the most common cause of trisomy 21 (down syndrome)
    maternal dislocation
  98. this cause of trisomy 21 is due to part of 21 gets stuck on some other chromosome before replication
    translocation
  99. this cause of trisomy 21 is due to only some cells in the body having 3 copies, individuals are often phenotypically normal
    mosaicism
  100. which congenital syndrome has a decreased Moro reflex, small head, up slanting palpebral fissures, macroglossia and thick neck
    trisomy 21 (down syndrome)
  101. which type of hearing loss is the majority of cases of in Down syndrome, affects the cochlea and nerves (inner ear) from repeated noise exposure
    sensorineural
  102. this type of hearing loss associated with Down syndrome is caused by dysplasia of the ossicles and will have scarring due to repetitive ear infxs
    conductive (middle ear)
  103. what are some eye defects associated with down syndrome
    • *brushfield spots* (white/gray collection of CT on iris)
    • ectopic lends
    • refractive errors
    • strabismus (cross-eyed)
    • cataracts
  104. in pts with trisomy 21, what are the causes of endocardial cushion defects
    • atrial septal defect
    • ventricular septal defect
  105. in a pt with trisomy 21, what can occur with a  left to right shunt
    • pulmonary HTN
    • if untreated, HF develops and becomes irreversible (Eisenmengers syndrome)
  106. which lab/radiologic procedure is a must for a pts with trisomy 21
    echocardiogram
  107. which congenital abnormality is associated with 2 collections of air with air/fluid levels on a xray (double bubble) and what is the dx
    trisomy 21 and esophageal or duodenal atresia
  108. which skeletal abnormality is associated with trisomy 21
    atlanto-axial instability
  109. which congenital abnormality is the most common drug-induced congenital defect
    fetal alcohol syndrome
  110. these common characteristic facies is associated with which congenital anomaly:
    short palpebral fissures
    indistinct philtrum
    thin upper lip
    FAS
  111. these extremity abnormalities are associated with FAS
    • clinodactyly (pinky finger bends toward the ring finger)
    • hockey stick crease
  112. what developmental abnormalities are associated with FAS
    • mental retardation
    • fine motor delay
    • ADHD
  113. which congenital syndrome is associated with multiple repeats of the X chromosome
    fragile X syndrome
  114. which congenital syndrome pts have an above average memory for events and directions and have a good sense of humor (pranksters)
    fragile X syndrome
  115. a pt with an oblong face, large ears, and large testicles is associated with which congenital syndrome
    fragile X syndrome
  116. which congenital syndrome is associated with a webbed neck, shield chest (widely spaced nipples) and a triangular face
    Turner syndrome
  117. neonatals may show this symptom for Turner syndrome
    extremity edema
  118. which congenital syndrome is associated with coarctation of the aorta, bicuspid aortic valve and early HTN, has a lack of secondary sex characteristics
    Turner syndrome (45XO)
  119. which endocrine D/O's are associated with Turner syndrome (45XO)
    • hypothyroidism
    • DM type 1
    • osteoporosis
  120. when is estrogen replacement therapy started in pts with turner syndrome (45XO)
    14 y/o
  121. this congenital syndrome traits results from a deficiency in testosterone, primary hypogonadism
    Klinefelter syndrome (47XXY)
  122. this congenital syndrome is autosomal dominant, has a mutation in the gene that makes fibrillin
    marfan syndrome
  123. Dilation of the aortic root, arachnodactyly, and ectopia lentis is associated with which congenital syndrome
    Marfan syndrome
  124. in Marfan syndrome what is a positive thumb sign called
    steinberg test
  125. in Marfan syndrome, what is the name of a positive wrist sign
    walker sign (test)
  126. how is Marfan syndrome confirmed
    FISH studies (fluorescent in-situ hybridization)
  127. what is the radiologic procedure used in Marfan syndrome
    aortic sonography (aortic arch, root, valve)
  128. a WBC count of what implies that the kid is sick
    >15K in a child >1 y/o
  129. when diagnosing a fever, what I/T ration is strongly suggestive of sepsis
    I:T >0.2 (>1:5)
  130. which children with fevers need to be evaluated
    • < 3mo's
    • fever > 105
    • lethargy, < oral intake
    • MS change, nuchal rigidity, petechial (N meningitides)
  131. this disease is caused by the paramyxovirus, has a 10-14 day incubation, and the pt is infectious 1-2 days before the rash
    Rubeola (affects the soles)
  132. pt comes in with a 103 fever, has a cough, coryza, and conjunctivitis with some noticeable tiny white spots on a red base in the oral mucosa. You notice his/her rash is a blanching maculopapular rash. What is your suspected dx
    rubeola
  133. a pt comes in complaining of post-auricular and occipital lymphadenopathy and has rose colored spots on the palate (Forschheimer spots). What is you suspected dx
    rubella
  134. which disease can cause a "blueberry muffin baby" if it is a intrauterine infx
    rubella
  135. this disease is caused by the parvovirus B19, is associated with winter-spring epidemics, you noticed the pt has a slapped cheek appearance with paleness around the lips. what is your suspected dx
    5th disease (erythema infectiosum)
  136. what is stage 1 of 5th disease
    slapped cheek appearance, pale around the lips
  137. what is stage 2 of 5th disease
    redness moves to extensor surfaces, trunk
  138. what is stage 3 of 5th disease
    patchy resolution with reticular, lacy, net-like pattern
  139. which disease can cause aplastic crisis in SS and thalassemic pts
    5th disease
  140. this disease is caused by human herpes virus type 6 & 7, and is the most common exanthema in children < than the age of 3, the child presents as a well-appearing child with a high fever for 2-5 days
    roseola
  141. this disease is caused by the varicella-zoster virus, is high infectious, rare before the age of 6 months, has a dew drop on rose pedals (red spot with clear vesicles), and pruritus is a common finding
    varicella
  142. how long is a child with varicella contagious
    until all lesions have been crusted over
  143. this disease is caused by the coxackie A virus, the pt will have red based vesicles but most often are eroded by time they are seen by a provider
    hand, foot, mouth disease
  144. what is the most common cause of occult bacteremia in neonates
    Group B strep
  145. what is the most common cause of occult bacteremia in infants/children
    pneumococcus (strep pneumo)
  146. what are the indicators of increased risk for having occult bacteremia
    • age < 36 months
    • temp > 102.1
    • WBC >15000, I:T >0.2
  147. what are the two big sources for fever without an obvious source
    • UTI
    • pneumonia
    • (also skin)
  148. what are the toxic signs in a fever without an obvious source
    • change in crying pattern
    • drowsiness, depressed consciousness
    • inconsolable, moaning
    • abnl lung findings, dyspnea, tachypnea
    • poor peripheral circulation, petechial, loss of skin elasticity
    • meningeal signs, seizures
  149. in a fever without a known source in a baby less than 1 month of age, after getting labs what medications do you begin immediately
    • ampicillin
    • gentamicin
  150. in a fever without a known source, what are the drugs used to treat a 1-36 month old
    rocephin or claforan
  151. when would you do a LP in a child ages 1-36 with no toxic signs and has a fever without a known source
    if 1-3 months and if WBC is <5K or >15K and no pyuria or bactiuria
  152. how do you treat a child between the ages 1-36 months that does not appear toxic with a fever without a known source
    • rocephin or claforan
    • suprax (UTI)
    • amox or zithro (respiratory)
  153. what is the definition of a FUO
    fever greater than 14 days; H&P show no obvious cause
  154. what is the most common cause of a FUO
    UTI
  155. if a pt has a high fever with rapid defervescence in a FUO what could be the dx
    JRA, lymphoma, TB
  156. if a pt has a high fever with elevated baseline, what could be the cause of a FUO
    infections
  157. if a pt has a high fever without fluctuations, what could be the cause of a FUO
    typhoid
  158. what is the common cause of septic (bacterial) meningitis in neonates
    GBS
  159. what is the common cause of meningitis in infants
    strep pneumo
  160. what is the common cause of aseptic (non-bacterial) meningitis
    • viral: enteroviruses
    • fungal: Cryptococcus (behavioral changes)
  161. if a pt has petechial with fever, what type of meningitis is it
    Neisseria meningitis
  162. what is a positive Kernig sign
    lift leg 90 degrees then extend it, it the pt resists or complains of pain it is a positive sign
  163. what is a positive Brudzinski sign
    flex the pts neck and the knees will come up
  164. how is neonate meningitis treated
    amp and gent
  165. how are infants/children treated that have meningitis
    rocephin
  166. how are close contacts of pts with meningitis treated
    rifampin x 2 days (tell pts that their secretions will turn red)
  167. what are the most common causes of post-neonate encephalitis
    • arbovirus
    • enterovirus
    • HSV
  168. how do pts with encephalitis usually present
    focal or global neurological defects
  169. a blue-black or dark purple congenital patch on low back. upper buttocks, common in Asians is known as what
    Mongolian spots
  170. hemophilic pts bleed into where
    joints and muscles
  171. platelet disorder pts bleed into where
    GU, mucosal or extremity petechia
  172. what will you see on a pt with a human bite mark
    arch shape ecchymosis
  173. if you see needle like punctures in the skin of a pt what do you think bit them
    a cat
  174. a dog bite is characteristic of what type of bites
    tears and crushing of tissue
  175. what types of fx are common with abuse
    • spiral
    • bucket handle (metaphyseal)
  176. which bones are unlikely to be fractured accidentally
    • scapular fx
    • ribs (posterior)
    • spinous process
    • skull (non-linear)
    • sternal fx
  177. how long does it take for new periosteal bone and calluses to form
    7-14 days
  178. how long does it take to have a loss of definition of the fx line, and trabecular formation of the callus
    14-21 days
  179. how long does it take for a callus to become more dense
    3-6 weeks
  180. how long does it take for subtle, fusiform sclerotic thickening
    > 6 weeks
  181. what are the two types of hemorrhages seen is shaken baby syndrome
    • retinal
    • subdural
  182. what is the interview mnemonic for adolescents
    • H- home
    • E- education, employment
    • A- activities, hobbies
    • D- drugs
    • D- diet
    • S- suicide
    • S- sexuality
  183. what are the first signs of secondary sexual characteristics
    • testicular enlargement for males
    • thelarche for females
  184. when does the growth spurt occur
    • tanner stages 2 and 3
    • females- just before 12
    • males- just before 14
  185. which tanner stage in males is the prepubertal phase (penis < 3cm, no pubic hair)
    stage 1 (<9 y/o)
  186. which tanner stage in males is when the testes enlarge, scrotum thins, and gets redder and straight pubic hairs appear
    stage 2 (9-11.5 y/o)
  187. what tanner stage in males is when the penis lengthens and pubic hair darkens and curls
    stage 3 (11-13 y/o)
  188. what tanner stage in males is when the penis widens and hair fills in
    stage 4 (12.5- 15 y/o)
  189. what tanner stage in males is when development is complete and hair is filled in completely
    stage 5 (14+ years)
  190. what tanner stage in females is the prepubertal phase where there is no glandular tissue
    stage 1 (<10 y/o)
  191. what tanner stage in females is when there are breast buds (under areolar) and straight hair appears on labia majora
    stage 2 (10-11.5 y/o)
  192. what tanner stage in females is when the breast enlarge (outside areolar) and pubic hair darkens and curls
    stage 3 (11.5-13 y/o)
  193. what tanner stage in females is when the areolar protrude from breast, hair fills in incompletely
    stage 4 (13-15 y/o)
  194. what tanner stage in females is when the areolar rejoin the breast contour (not all) and the hair fills in completely
    stage 5 (14 y/o)
  195. what is included in the female athlete triad
    • disordered eat (anorexia, bulimia)
    • menstrual dysfunction (delayed menarche, absence of menstrual cycle)
    • osteoporosis (increased risk of stress fx, low bone density)
  196. what is the definition of obesity using the IBW scale
    • >120% IBW= obese
    • >200% IBW= morbidly obese
  197. what is the definition of obesity using the BMI scale
    >95%ile for age
  198. what is the direct sequela of obesity
    • DM
    • hyperlipidemia
    • HTN
  199. what is the indirect sequela of obesity
    • nonalcoholic steatohepatitis (fatty liver)
    • slipped capital femoral epiphysis
    • OSA
    • psychosocial problems
  200. what are black heads known as
    open comedones
  201. what are white heads known as
    closed comedone
  202. inflammatory comedones are composed of what
    P.acne colonization of comedones
  203. which acne stage consists of minimal papules (some inflammation) with no scarring or cysts
    stage 1 (comedonal acne)
  204. which acne stage consists of facial papules/pustules (only) with mild scarring but no cysts
    stage 2 (papular acne)
  205. which acne stage consists of extrafacial and facial papules/pustules, has moderate scarring and occasional cysts
    stage 3 acne
  206. which acne stage consists of severe papules/pustules throughout, has severe scarring and cysts are common
    stage 4 acne
  207. which topical acne treatment has potent antimicrobial activity with mild keratolysis, inactivates retinoids and may bleach clothes and bedding
    benzoyl peroxide
  208. which topical acne treatment normalized keratinization and reverses epidermal adhesiveness and decreases comedo formation
    retinoids
  209. when prescribing retinoids to a pt, what do you want to educate them on
    • will often have transient worsening of acne
    • causes photosensitivity, skin dryness
  210. which topical antibiotic treatment can cause a yellow tinge to the skin, can make pts more sensitive to sunburns, and will glow with a UV light
    topical tetracycline
  211. which foods do you want to instruct your pts to avoid when using oral tetracyclines
    • milk
    • antacids
    • Fe
  212. what are the side effects of oral tetracyclines
    • graying of teeth in <12 y/o
    • photosensitivity
    • decreased OCP
    • yeast infx
    • GI side effects
  213. which oral antibiotic acne treatment causes vertigo, lupus and pseudomotor cerebri
    minocycline
  214. which acne medication requires the pt and provider to enroll into iPledge, is only a 20 week course, and causes severe xerosis along with the pt must be on 2 forms of BC because of the extreme teratogenicity
    isotrentinoin
  215. how is noninflammatory acne treated
    • retinoids
    • acids
  216. how is inflammatory acne treated
    • benzoyl peroxide
    • topical antibiotics
    • oral antibiotics
    • OCPs
    • isotrentinoin (leave for dermatologists)
  217. any visible or palpable development of the mammary gland in boys or men is known as what
    gynecomastia
  218. when is gynecomastia usually benign
    <3cm
  219. when is gynecomastia prevelent
    • infancy
    • age 11-14 (tanner stage III-IV)
    • elderly
  220. which congenital syndrome could be related to gynecomastia
    47XXY (kleinfelters)
  221. when do you refer a pt with gynecomastia to an endocrinologist
    • >3cm, persists after 2 years duration or past age 17
    • occurs in tanner stage 1,2,5
  222. what labs are to be drawn if referring to endo
    • HCG
    • LH
    • estadiol
    • testosterone
    • DHEAS
    • LFT
    • TSH
    • creatinine
  223. what is the only approved med to treat a child with depression
    fluoxetine

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