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Pediatrics ICM

Terms in this set (98)

orderly sequential process that proceeds step by step from simple to complex
child development
characterized by increasing specificity of function as well as integration of these specific functions into a larger response
development
what direction does physical devt proceeds
cephalocaudal and proximodistal
time during which specific condition or stimulus is necessary for normal development of a specific structure
Critical/sensitive periods
Devt domains
Gross Motor
Fine motor
language
cognitive
social
what is developmental milestone
set of functional skills or age-specific tasks that most children can do at a certain age range
what is growth of rain during critics period dependent on
experience and influenced by social forces
importance of right brain in devt
association b/w maternal-infant interactions , early programming of hypothalamic-pituitary-adrenal axis and in health and disease
-
when are neurons and synapses developed
neurons before birth
synapses from last trimester of pregnancy to 18-24 mo
when developmental testing
9 mo
18 mo
24 mo
when autism screening
18 and 24 mo
when maternal depression usually
0-6 mo
Mid parental height calculation
Boys: (mom gt + 5in) +Father ht/2
Girls: Mom ht + (Father ht-5in)/2
Ages & Stages Questionnaires: age range covered, areas screened
Age range: 1-66 mo
Screened: Communication, gross motor, fine motor, problem solving, and personal-social
intervention for: Gross motor, fine motor, personal-social, language problems
gross motor: PT
fine motor: PT/OT
Personal/social: OT
Language: Speech therapy
developmental milestones and challenges in infant 0-1yo
-disapperance of primitive reflexes
-cephalocaudal/proximodistal progression of motor milestone
- maternal depression
-development and evolution of social skills: social smile and stranger anxiety
-sleep problems
- colic
development milestones and challenges in toddler (1-5yo)
- separation and autonomy in 2-3yo
- feeding problems
- toilet training
- temper tantrums
-language development
-learning and concept of school readiness
development of middle childhood (5-11yo)
-emerging independence
-friends
-sports
- control of emotions
-extracurricular interests
-understand concerts without having direct hands-on experience
-common issues: Enuresis, attention deficit, bullying, encopresis
puberty sign
-Girls 2yr ahead of boys
-girls: ovarian enlargement and s any physical sign
-boys: testicular enlargement
age appropriate diet in babies
-4-6mo: breast milk exclusively (+Vit D 400U/day)
- baby food 4-6 mo
- whole milk at 12 mo
benefits of breastfeeding
-GI: improved growth and motility
- prevent infections: breast-fed compared with formula-fed infants have lower rates of diarrhea, rest tract illness, acute and recurrent otitis media, and UTI
- Long term: obesity, adult CVD, childhood cancer, allergic conditions, DM, cognitive development
this part of brain still developing through puberty and young adulthood
prefrontal cortex
-hormonal and stress hormones complex effects
- pruning where loss of weak connections
type of thinking during: 10-13, 14-16, 17-21 and young adults
10-13: concrete
14-16: transitional
17-21: formal operational
18-25: executive functioning
hypertrophy of muscular layers of pylorus causing obstruction of gastric outflow most common in male children
pyloric stenosis
- cause largely unknown but more increase in maternal smoking, macrolide antibiotic exposure in first 2 wks of life
pyloric stenosis presentation
-3 to 8 wk old infant
- Nonbilious projectile vomiting
-infants still very hungry
-poor growth or failure to thrive
-Peristaltic wave in RUQ abdomen, "olive" mass** in right mid to upper quadrant
how to diagnose pyloric stenosis
-Ultrasonography (Gold st)
- upper GI barium study
- Labs: dehydration, hypokalemic hypochloremic metabolic alkalosis, unconjugated hyperbilirubinemia
Tx of pyloric stenosis
- Admit, NPO, correct dehydration and electrolytes
- surgery: pyloromyotomy
portion of bowel telescopes into another party
intussusception
most common cause intestinal obstruction in children b/w 6-36 mo more common in males
intussusception
- usually oleo-colic
**related to HSO
cause of intussusception
-usually idiopathic in hunger kids
-older: mockers diverticulum, intestinal polyp, HSP, cystic fibrosis, appendicitis, etc
intussusception presentation
-intermittent, colicky/crampy abdominal pain
- later lethargy and somnolescence
-vomiting
- currant jelly stools
- sausage shaped mass in abdomen
-Classic Triad **: AP, currant jelly stool, abdominal Mass
Intussusception diagnosis
-X-ray:nonspecific, not diagnosis
-U/S: target or donut sign (98-100% accuracy) WHEN its happening**
-CT
- Enemas(now mainly used for treatment/reduction)
Intussusception treatment
-Barium enema:can cause barium peritonitis, infection, radiation exposure
- US-guided pneumatic (air_ enema
- Surgical
necrotizing enterocolitis def
disease of neonates characterized by ischemic necrosis and inflammation of intestine
- unknown pathogenesis but may be from GI compromise, bacteria. enteral feedings
Bells staging criteria of Necrotizing enterocolitis
Stage I (suspected NEC)
II: Definite NEC
III: advanced NEC, severely ill
necrotizing enterocolitis treatment
- stop enteral feeds
- nasogastric decompression
-frequent lab and radiologic monitoring
- broad spectrum IV antibiotics
-surgery
obstruction of bowel by thick, adhesive meconium
meconium ileus
condition associated with meconium ileus
80-90% associated with CF
meconium ileus presentation
-progressive abdominal distention within the first 12-24 hrs of life
- bilious vomiting
- failure to pass stool
how to diagnose meconium ileus
contrast enema
treatment of meconium ileus
-gastrografin enema with aggressive hydration can be used to treat some
- operative evacuation of meconium
-proximal bowel dilated and distal bowers may be very small and require time to dilate with use
Hirschsprung disease "Congenital ganglionic megacolon"
absence of ENS ganglion cells in intestinal segment continuously to internal anal sphincter
-abnormal progression from neural crest
-most affect recto-sigmoid colon
- higher of males
- remember in Trisomy 21
HD presentation in newborn
-abdominal distention, bilious vomiting
- rectal exam: absence of stool in distal rectum, tight anal sphincter, explosive release of stool upon withdrawal of finger
-enterocolitis: life threatening with fever, vomiting, diarrhea, distention, megacolon
HD presentation in infant/child
- constipation +/- fecal impaction that begin in infancy
-lack of avoidance/withholding behavior
-poor weight gain
- refractory constipation to conventional therapy
diagnosis of HD
- Abdominal X ray
- Unprepared contrast enema
-biopsy (GOLD Std): no ganglion cells
- anorectal manometry
HD treatment
- soft rectal tube : decompression, saline irrigation
- Surgery
-identifying enterocolitis clinically
acute infectious process of GI tract that starts with fever, vomiting, abdominal pain then diarrhea with resolution of emesis (etiology can be viral, bacterial, or parasite)
Gastroenteritis
common organisms in bacterial gastroenteritis
E.Coli
Salmonella
Shigella
C. Difficile
C. Jejuni
Yersinia enterolitica
Hemolytic uremic syndrome
-shiga toxin producing EHEC (O157:H7)
-Prodrome of AP, nausea. vomiting, bloody diarrhea
treatment of HUS
-AVOID antibiotics
-better hydration leads to better outcomes
pathophysiology of Antibiotic associated diarrhea in kids <2
- disrupt fecal flora with overgrowth of enteropathogens
-Broad spectrum antibiotic
-Check for C.diff
-Recommend probiotics
C. Difficile colitis
-overgrowth of toxin-producing clostridial organisms
-Present: acute watery diarrhea with lower abdominal pain, fever, leukocytosis
-Risk: antibiotics, long term PPI, IBD, CF, Hirschrpung
Test of choice for C. Difficile
- PCR for genes encoding for Toxin A or be
-can be done in 2 stages: screen for enzyme immunoassay for C. diff GDH (high sensitivity), confirm with toxin PCR
Treatment for C. difficile
Vancomycin
fecal transplant
things you should ask about family history
prior pregnancies
known congenital disease
murmurs
early cardiac deaths
hypertriglyceridemias
observation during cardiac evaluation
-stigmata of genetic disease
- resp. rate/dyspnea/retractions
-color
edema
thoracic deformity
clubbing
what low pulses sign of
low output
coarctation
what increased/bounding pulses a sign of
diastolic runoff (PDA, AI, AVM)
high output states
thrill
usually indicative of loud murmur
Second heart sound splitting
-normally varies with respiration (increased venous return with inspiration; pulmonary sound 2nd)
- best heard at ULSB
- at high rates, may be difficult to hear
single second heart sound
if single:
-pulmoanry HTN
-one semilunar valve: PA, truncus, HLHS
-P2 not audible: DGTA, ToF, critical PS
widely split and fixed S2
-volume overload (ASD, PAPVR)
-Pressure overload (PS)
- electrical delay (RBBB)
Third heart sound
-related to rapid ventricular filling
-best heart at apex and LLSB
- common in kids
-Loud S3 abnormal: dilated ventricles, decreased compliance
"Kentucky gallop"
S4
- low frequency sound in pre systole: atrial kick
-always pathologic: decreased compliance
"Tennessee gallop"
heart sound clicks
semilunar valve stenosis
mitral valve prolapse
rub suggestS?
pericardial effusion
how to describe murmurs
-intensity (Grading)
- phase (systole, etc)
- frequency (pitch)
timing
quality (harsh, etc)
shape (crescendo, etc)
location
radiation
grading
I= barely audible
II= soft but readily heard
III= moderates aloud
IV = thrill
V = stethoscope on edge
VI = stethoscope off chest
begins after S1 and ends before S2, diamond shaped and caused by increased flow or obstruction to flow
systolic ejection murmur
pulmonary valve stenosis murmur
- often asymptomatic
- Grade II-VI
- ULSB, radiation to back
+/- click
Atrial septal defect
relative pulmonary stenosis
grade II-III
Fixed, widely split S2
+/- diastolic tricuspid flow murmur
aortic valve stenosis
Grade II- VI
URSB and radiates to neck
+/- click
notch thrill
coarctation of aorta
I-III
-ULSB, left back
weak or absent femoral pulses
systolic "regurgitant" murmurs
never innocent
begins with S1 and continues through S2
variably shaped
VSD
size of defect can vary: none to regurgitant to short systolic ejection
- Grade II- VI
-LLSB, MLSB
- associated diastolic rumble
mitral regurgitation
Grade II- III
Apex
high frequency
louder with valsalca
hallmark of rheumatic carditis
late systolic murmur with click, think mitral valve prolapse
machinery like murmur
PDA
diastolic associated with early mid and late diastole
early: semilunar
mid: AV valve stenosis
Late: atrial systole
mitral valve stenosis
mid-diastolic murmur
low pitched (use bell)
grade I-III
apex
what accentuates innocent murmurs
fever, anxiety
- pulmonary flow murmurs, Still's murmur, venous hum, physiologic pulmonary branch stenosis
pulmonary flow murmur
common in kids 8-14
-Grade I - III
-MLSB and LUSB
-systolic ejection
slightly grating quality
distinguished from ASK by normal S2
Stills murmur
innocent
3-6yr
II-III
MLCB, LLSB, apex
systolic ejection
vibratory, musical
louder supine
venous hum
innocent
3-6yr
infra and supraclavicular
continuous murmur with loud diastolic component
disappears when supine or with head motion
physiologic pulmonary branch stenosis
innocent murmur
common in infants (gone by 3-6mo)
I-II
ULSB with radiation to back and axillae
systolic ejection
neonatal sepsis def
systemic infections in infants <28 days of age
-bacterial pathogens
pathogens in neonatal sepsis
strep agalactiae
E coli
most common causee of sepsis in infant <30 days
viral infections
-enteroviruses, human parechoviruses, herpes simplex 1 and 2, hepatitis and pneumonitis = virus
initial antimicrobials for infants <1mo and those 1-23 mo
<1 mo: ampicillin 300-400 mg/kg/day divided every 4 hrs PLUS cefotaxime. if Grain stain with GNRs add gentamicin

1-23 mo: Vancomycin plus 3rd generation cephalosporin
treatment of acute otitis media
-Amoxicillin
-Amoxicillin- clavulanic acid
cefdinir, cefuroxime, and cefpodoixme ONLY if allergic to penicillin
antimicrobial agents for ABRS
Macrolide and TMP-SMS
notE: abot 13%S. Pneumo resistant to macrolides
when to change therapy for kids
duration 10-14 days for children
Kawasaki disease clinical diagnosis
Fever >5 days +4 principal features
- polymorphous exanthema
-bilateral bulbar conjunctival infection without exudate
treatment of lyme disease
doxycycline if >8yrs
amoxicillin if <8 yrs
name age: thinking and planning more abstractly with movement toward independence. trying to :fit in: and conform to peer values
middle adolescence (Age 14-16)
Name age: reduced restlessness and better integration, completed pubertal growth but body images issues may be significant with peers, ability to think more abstractly and plan for future
late adolescence (Age 17-21)
goal of health screening in adolescence
promote optimal physical, mental, emotional and social growth and development
what info is confidential for an adolescent
STD, contraception, pregnancy-related care, mental health, substance use
avg age menarche
12.4 years (2 yr after breast budding)
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