Peds Midterm Study Guide (ASSURED A)

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Peds Midterm Study Guide (ASSURED A) 1. Children are able to sit without extra support at what age? 6-8 month olds should be able to sit briefly without extra support, 7-9 months old sit well inde... pendently. 2. Types of car seats (see also #60): Appropriate ages and weights for forward and rear facing seats. When can kids ride in the front seat of the car? 13 years old. When should they use booster seat? 4-8 years old The AAP recommends: ● Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more. ● Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds or more. ● When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old. ● When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection. ● All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection. 3. Recommended vaccine schedule (many questions): https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Items 3, 6, 46, and 85 in this study guide address vaccines) 4. Child abuse questions: ○ What age is it appropriate to have certain types of fractures? Metaphyseal fractures, multiple differently aged posterior rib fractures, complex or multiple skull fractures, spinous process or scapular fractures are suspicious in children. ○ When should you be concerned about a young infant with tons of bruises (eg - if they are not walking yet would be unusual)? Long bone fx are unusual in young infants. ○ When is it necessary for you to report? Anytime you suspect any sort of abuse. ○ Who do you report to? CPS. ○ Do you face any repercussions? Should not. ○ Any fracture in a non-ambulatory infant without clear accidental and consistent mechanism should raise a red flag. (items 4, 5 and 29 in this guide address child abuse) 5. Toddler abuse: There will be a list of injuries. Which would be caused by abuse? ○ Bruises TEN4 by AAP i. T- torso; E- ear; N- neck; 4- in children less than or equal to 4 years and ANY bruise in children less than 4 months Peds Midterm Study Guide ○ Injuries tend to occur away from bony prominences (neck, head, buttocks, trunk, hands, and upper arms) 6. Contraindications of vaccinating children. Who should not receive a live vaccine? Immunocompromised, allergic reaction to a previous dose or component of vaccine, history of intussusception for Rotavirus See CDC sheet “vaccines by medical indication” https://www.cdc.gov/vaccines/schedules/hcp/imz/child-indications.html Immunocompromised should not receive: Rotavirus, MMR, influenza (LAIV) or varicella HIV infection should not receive: Influenza (LAIV), MMR or varicella Kidney disease should only cautiously receive influenza (LAIV) Asthma: No influenza (LAIV) CSF leaks: No influenza (LAIV) (Items 3, 6, 46, and 85 in this study guide address vaccines) 7. Young boy with mental retardation. He was a premie. They give a scenario. What caused his mental retardation? eg - understand congenital abnormalities, infections, preemie complications, chromosomal aberrations, brain tumor, serum blood levels ○ Important risk factors for intellectual disability (ID) include low level of maternal education, advanced maternal age, and poverty. ○ The causes of ID are extensive and include conditions that interfere with brain development and functioning. Among the known causes of ID, the majority are genetic abnormalities. i. A genetic cause can be identified in >50 percent of cases of ID in populations referred for specialty evaluation. Down syndrome is the single most common genetic cause of ID. X-linked disorders (including fragile X syndrome) account for approximately 5 to 10 percent of ID in males. De novo dominant mutations are an important cause of severe ID. ○ Metabolic disorders can cause ID or may be comorbid. ID can present alone or with neurologic abnormalities such as epilepsy or structural brain defects, or with other congenital anomalies. ○ Nongenetic prenatal causes of ID include congenital infections, and teratogens such as alcohol, lead, and valproate. Perinatal abnormalities account for up to 5 percent of ID and include preterm birth, hypoxia, infection, trauma, and intracranial hemorrhage. Postnatal and acquired causes of ID include accidental or nonaccidental trauma, central nervous system (CNS) hemorrhage, congenital hypothyroidism, hypoxia (eg, neardrowning), environmental toxins, psychosocial deprivation, malnutrition, intracranial infection, and CNS malignancy. [Show More]

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