Peds Final Exam - Keely TQs

At birth, how much bone is ossified?

30%

At birth, how much of newborn weight is water?

80%

When do children become biomechanically equivalent to adults?

Age 8-9

What is the term for age 0-1?

Infancy

What is the term for age 1-3?

Toddler

What is the term for age 3-8?

Early childhood

What is the term for age 9-11?

Middle childhood

What is the term for age 12-18?

Adolescence

How long should infants be exclusively breast/formula-fed for?

first 6 months

Before 6 months, what is the primary reflex of the tongue?

Tongue thrust reflex

T/F: At 9-11 months, you can add water to replace milk in the infant’s diet.

False - does NOT replace milk

What are two foods to avoid in the first year of life?

Honey and whole cow’s milk

How much moderate to vigorous physical activity should children and adolescents have daily?

60 minutes

How much sleep should a newborn get?

12-18 hours/day

How much sleep should a toddler get?

12-14 hours/day

How much sleep should a preschooler get?

11-13 hours/day

How much sleep should an elementary/middle school student get?

9-12 hours/day

How much sleep should a teenager get?

8-10 hours/day

Why should we not bath babies/kids every day?

Increased risk of normal skin flora

How often should kids bathe?

Infants: every 2-4 days

Toddlers: every 2-3 days

School-age: depends

Adolescents: daily

When should infants have their first dental visit?

6 months after 1st tooth eruption

T/F: Strong parental concern is considered a red-flag for developmental milestones.

True

What should you ask mothers about when taking the history of a child?

Maternal health during pregnancy

APGAR score

Feeding problems

What are red flags in infants?

Fever over 100.4

Sunken/bulging fontanelles (severe dehydration)

What are red flags in children?

Fever over 104

Difficulty breathing

Where is a child’s temperature MC taken? What is most accurate?

MC - tympanic

Accurate - rectal

Where can you get the most accurate/best pulse?

Femoral pulse

What 3 tests are performed for growth parameters?

Weight

Height/length

OFC → across frontal-occipital prominence - greatest diameter

What is the pattern for respiration?

Respiratory rate starts high

HR starts high

Systolic BP starts LOW

What is the expectation for a kid and their growth curvature?

Stay in their percentile

What is a red flag for weight loss?

loss of 5% of body weight

What is the 3rd leading cause of infant mortality in the US?

SIDS

When is the highest risk for SIDS?

2-4 months

What are the risk factors for SIDS?

Male

Poor socioeconomic conditions

Young maternal age

Smoking

What are the ABCs for preventing SIDS?

Alone

Back

Crib (no bed sharing for first 6 months)

What is the rule of 3 for colic?

3 hours of unexplained crying

3x/week

3 weeks

What are the 5 S’s of colic?

Swaddling

Side/stomach lying

Shushing

Swinging

Sucking

What is the term for white, pinhead-sized papules in an infant?

Note: these will self-resolve

Milia (MC around face)

When do hemangiomas resolve?

Adolescence or earlier

What is the term for a flat hemangioma that does NOT resolve over time?

Port wine stain

When is a port wine stain most concerning and what is the DDX?

Lateralized & localized to forehead and upper eyelid

Struge-Weber diagnosis

What is the term for red scaling on the head, face, or yellow greasy rash on the head?

Seborrheic Dermatitis

AKA cradle cap!

What do cafe-au-lait spots indicate?

Neurofibromatosis

What is the MC cause of hives?

Acute (<6 weeks): allergic reaction

Chronic (>6 weeks): underlying disorder

What is the term for a honey-colored sticky crust?

Impetigo

What is the MC scabies symptom?

Intense itching

What DX is indicated by a ‘strawberry tongue’?

Scarlet fever

What disease is indicated with a dull, red-ringed shaped lesion with a raised border?

Tinea corporis - ringworm

When does the anterior fontanelle close?

4-26 months

When does the posterior fontanelle close?

2 months

How do we monitor brain growth?

Head circumference

What are 2 red flags when assessing fontanelles?

Bulging - increased IAP

Sunken - severe dehydration

What is a red flag for non-accidental trauma?

Subconjunctival hemorrhage

T/F: Strabismus is a normal finding until 6 months.

True

When does fixation on objects begin?

2-4 weeks

When does visual tracking begin?

5-6 weeks

When does visual acuity rapidly increase from 20/400 to 20/40?

First 6 months

What are the 4 D’s of the ear?

Discharge → otitis media/externa

Discoloration (Battle Sign) → head trauma

Deformity → disability

Displacement → away from skull

When should the otoscopic exam be performed?

At END of complete examination

In infants, in what direction do you pull the auricle?

Inferior & posterior

In older kids, what direction do you pull the auricle?

Superior & posterior

What is the hallmark sign of a foreign object in the nose?

Green, foul-smelling purulent discharge from one side

More than 90% of cases of pharyngitis/tonsilitis are caused by _____ infection.

Viral

T/F: Thrush in the mouth does NOT wipe away easily.

True

What are the primary findings of meningitis?

Severe headache, nuchal rigidity, and fever

What reading on a pulse oximeter should warrant a trip to urgent care?

90-95%

What are some abnormal breath sounds?

Rales, wheezes, rhonchi, friction rubs

What technique can be used in infants to percuss the lungs?

Finger on finger method

What is the Dx for a seal-bark cough?

Croup

What is the MC chronic lung disorder in children?

Asthma

What is dry asthma related to?

Sympathetic nervous system

In a patient with acute bronchitis, what is there a history of?

Mild UPPER respiratory tract infection

RSV is a progression from what?

Lower respiratory tract illness

What can occur 2-6 weeks after streptococcal infection?

Acute Rheumatic Fever

may be accompanied by new heart murmur - carditis

What is the MC cause of bowel obstruction in first 2 years after newborn period?

Intussusception

How many kids experience gastric reflux?

90%

What are the MC symptoms of GER?

Delayed gastric emptying with forceful vomiting

What can help with GER?

Formula thickening

What diagnosis is associated with red currant jelly stool?

Intussusception (telescoping)

What diagnosis is associated with non-billous vomiting, and usually projectile after feeding?

Hypertrophic pyloric stenosis

What are the primary findings of appendicitis?

Normal WBC count

Fever at 100-102 degrees

T/F: Acute gastritis involves a HIGH risk of dehydration

True

What often causes constipation in kids?

Painful defecation → voluntary withholding

What is the correlation between scoliosis progression and Risser score?

Lower score → higher risk of progressoin

What is the treatment based on curve severity of scoliosis?

<20 → chiropractic care with reassessment

20-40 → conversative treatment, bracing, co-management

>40 → bracing, surgery, risk of cardio/neuro issues

How is muscular dystrophy passed on?

MC in males → X-linked recessive

In muscular dystrophy, when is there a loss of ambulation?

10-14 years

T/F: Muscular dystrophy is rarely symptomatic in infancy.

True

What are the hallmarks of osteomyelitis?

Localized tenderness

Pain on weight bearing

Erythema

Warmth

Swelling

Fever & Elevated Pulse

What are recurrent episodes of UTIs indicative of?

Non-accidental trauma

An infant turning their head toward a sound happening in another room is an example of testing for what CN?

CN 8 - vestibulocochlear

Examining an infant while crying is assessing what CN?

CN VII - facial

Observing an infant sticking out their tongue is assessing what CN?

CN XII - hypoglossal

An infant being able to hold their head up during tummy time is assessing what CN?

CN XI - spinal accessory

An infant sucking and swallowing while feeding is assessing what CN’s?

CN IX & X - glossopharyngeal and vagus

How should non-emergent illnesses be managed?

Begin chiro care ASAP

Parents monitor temp every ~2 hours

Monitor for signs of progression

At birth, the brain is ___% body weight?

10%

Body is 85% water

How many connections does each neuron develop within the first year?

1,000 - 100,000

When does the rooting reflex integrate?

3-4 months

T/F: The rooting reflex should NOT be tested immediately post-feed.

True