SARAH MICHELLE CRASH COURSE STUDY GUIDE SOLUTION NEW UPDATE
2024
Developmental milestones
-anterior and posterior fontanelles close- 2-3 months
-strabismus clear up- 4-6 months
-roll tummy to back- 6 months
-palmar grasp goes away- 6 months
-sit up unassisted- 9 months
-feed self with fingers- 9 months
-anticipate separation anxiety- 9 months
-pull to a stand- 12 months
-say mama/dada-12 months
-hold a spoon-12-18 months
-walk- 18 months
-say worders other than mama/dada-18 months
-scribble- 18 months
-kick a ball- 2 years
-cop a circle/throw a ball/ride a tricycle- 3 years
-When should bowlegs go away? - 3 years
-draw a cross- 4 years
-draw a person with body parts- 4 years
-catch a large ball- 4 years
-counting to 10- 5 years
-hopping on 1 foot- 5 years
-riding a bicycle-5-6 years
Sunken fontanels- concerning for dehydration- ED
Birth weight doubles at 6 months
Birth weight triples at 12 months
Reflexes present at birth
-rooting
-tonic-neck
-grasp
,-moro
-stepping
effective breastfeeding
-6-8 wet diapers a day
-gaining weight
-vitamin D supplements
Start giving live vaccines
-12 months because maternal antibodies can interfere with immunity prior to this age.
Children that should not get a live vaccine
immunocompromised (such as on high doses of steroids or IG).
Patient doesn't know vaccination status
give them everything
-< 7- DTAP
-> 7- TDAP
Older child with no vaccines
-IPV, TDAP, MMR, Meningitis, HPV, HBV, HIM, Varicella, Flu, pneumonia, HEB.
-Xray: thumbprint
Newborns
-a bilirubin > 15 indicates need for phototherapy
Rhino blastoma or congenital cataract
-parents bring a child in and you find leukocoria on fundoscopic exam.
Tanner stages
Girls
1: nothing
2: budding
3: 1 mound
4: 2 mounds/start of period
5: everything
Boys
1: nothing
2: nothing
3-4: growth spurt/penis grows the most length
5: everything
Puberty
-starts in tanner stage 2
-2-3 years after puberty is when a girls starts period
-age 16, no period, investigate further
-start period, grow 2-3 more inches within 2 years
too early for puberty
-< 8 year old in girls
-< 9 year old in boys
Anorexia and Bulimia
,-high risk for bone loss and heart disease (anorexia)
-dental erosion, esophageal issues (bulimia)
-sx improvement: anorexia, increases menses, weight gain
Salter-Harris fractures
-occurs along growth plate in long bones
-if not corrected, may stunt child's growth
-type 3 refer to ortho
Cryptorchidism
-testes that are not within the scrotum
-worried about testicular cancer in the future
hydrocele
-abnormal accumulation of fluid around the testes
-can be born with it or with injury/inflammation
-reassure parents, typically resolves on own, surgery if persists pass 2 years of age.
Slate gray nevi (Mongolian spots) (congenital dermal melanocytosis)
-bluish discoloration on a two-week-olds back
-not painful
-flat and smooth
-likely resolve on own by 6-10 years of age
Acute otitis media in pediatrics
-bulging inflamed TM
-Amoxicillin
-PCN allergy: cephalosporins, azithromycin, Bactrim
-untreated- mastoiditis, worsening pain, postauricular tenderness, fever
-refer to ENT
Otitis externa (swimmers' ear) in pediatrics
-drainage is very malodorous
-external ear tenderness
-usually, pathogen is pseudomonas aeruginosa
-ABX ear gtt- ofloxacin, sometimes steroid gtts added
Tympanic membrane rupture
-ear pain, sudden bloody drainage
-likely will heal on own, can refer to ENT
-recheck in 4 weeks
chronic otitis media
-can lead to possible hearing loss, which could delay speech
cholesteatoma
-cauliflower like growth
-refer to ENT
otitis media with effusion
, -likely related to allergies
-effusions can last up to 12 weeks
-watch and wait
coarctation of the aorta
-heart defect, typically present at birth
-Increased BP in arms, Decreased BP in legs
-diminished LE pulses
Symptoms an infant can show with undiagnosed heart defect
respiratory distress, increased RR, retractions, nasal flaring, diaphoresis, pulmonary
edema.
VUR: Vesicoureteral reflex
-urine flow backs up into the ureters and leads to dilation of the kidneys
-VCUG (voiding cystourethrogram) used to diagnose
-graded on a scale of 1-5
-refer to urologist
Fetal alcohol syndrome
-thin upper lip, smooth philtrum, low nasal bridge.
Typical causes of acne in adolescents
-genetics or increased androgens
-Treatment: Benzoyl peroxide, topical retinoids and or topical antibiotics, oral antibiotics.
-none working? - dermatology for Accutane.
-working but face is irritated, reduce frequency of regimen.
turners syndrome
-female adolescent, shorter statue, webbed neck
-likely delayed puberty as well as issues with infertility
Osgood-schlatter
-adolescent
-pain over the anterior tibial tubercle near tendon insertion site
-cross country runner
-NSAIDs, ice
-likely outgrow when bones top growing
Foreign body
nasal pain, drainage from right Nare
keloid
-nose piercings
-grow over incision or site of injury
Kawaski disease
- fever > 5 days, strawberry tongue, peeling rash
-prompt treatment with IVIG, high dose aspirin, send to ER.
Pyloric stenosis
-projective vomiting, olive shaped mass on sternum
-ultrasound
-send to ER
Intussusception
-clenching stomach, jelly-like stools
-feel sausage-shaped mass
