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Wednesday, July 22, 2015

Pediatrics List of Most Commons for Physician Assistant Students

Most Commons in Pediatrics
  • Most Common Congenital Heart Lesions
    • Left-to-Right Shunts (Breathless)
      • VSD (Ventricular septal defect) - 30%
    • Right-to-Left Shunt (Blue)
    • Common Mixing (Breathless and blue)
      • Atrioventricular septal defect (complete) - 2%
  • Coarctation of the Aorta - most common site is ligamentum arteriosum
    • More common in males than females (3:1)
    • Pathognomonic signs: rib notching on CXR, “three sign” on CTA
  • Bronchiolitis - most common serious respiratory infection in children, most commonly occurring in the winter months due to RSV
  • Most common cause of hypothyroidism is congenital - detected on routine biochemical screening shortly after birth
  • Pyloric stenosis - most common cause of GI obstruction in neonate
  • Intussusception - most common abdominal emergency in early childhood
    • Most common cause: intestinal obstruction in infants 6-36 months
  • Functional encopresis - 3-6 times more common in males
  • Rhabdomyosarcoma - most common form of soft tissue sarcoma in childhood
  • Prolonged (persistent) neonatal jaundice - most common presentation of liver disease in neonatal period
  • Fanconi anemia - most common inherited form of aplastic anemia
  • Reactive arthritis - most common form of arthritis in childhood
  • Retinoblastoma - most commonly presents as white pupillary reflex replaced by the normal red one or with a squint
  • Hypospadias - common congenital anomaly affecting 1 in 200 boys
  • Urinary tract infection  - most common cause of hematuria
  • Hypertension - most common features are failure to thrive and cardiac failure
  • Endocarditis - most common causative organism is Streptococcus viridans
  • Non-Hodgkin Lymphoma - most common in childhood
    • Hodgkin Lymphoma - more common in adults
  • Brain Tumors - most commonly primary and most common solid tumor in children
    • Most infratentorial (60%)
    • Most common type: astrocytoma (40%)
  • Neuroblastoma - most common before age 5
  • CMV (Cytomegalovirus) - most common congenital infection
    • TORCH(E)S: the congenital infections transmitted transplacentally
      • Toxoplasmosis
      • Other (parvovirus)
      • Rubella
      • CMV
      • Herpes, Hepatitis, HIV
      • (e)
      • Syphilis
  • Asthma - most common chronic respiratory disorder in childhood (15-20%)
    • IgE mediated asthma (atopic asthma) - more common in children with eczema
  • Meningitis - most commonly caused by viral infection in children
  • Rotavirus - most common cause of foul smelling, watery diarrhea
  • Obesity - most common nutritional disorder affecting children and adolescents
  • Cerebral Palsy - most common cause of motor impairment in children
  • Leukemia - most common malignancy in childhood
    • ALL most common (80%)
  • Most common inherited coagulation disorders - hemophilia A and B
  • Respiratory Distress Syndrome (RDS) - most common in infants born before 28 weeks gestation; higher incidence the more preterm the infant
    • More common in boys
  • Cystic Fibrosis - most common life-limiting autosomal recessive condition in Caucasians (1 in 2500, carrier rate is 1 in 25)
  • Fragile X Syndrome - most common familial form of learning difficulties and second most common genetic cause of severe learning difficulties after Down Syndrome
  • Most common age for children to be admitted to a hospital - less than 1 year
  • Supraventricular tachycardia - most common childhood arrhythmia
  • Transient Synovitis (irritable hip) - most common cause of acute hip pain in children  
  • Spina Bifida: most common birth defect in US
    • Most common location is lower back
  • DDH (Developmental Dysplasia of the Hip): most common in breech deliveries
  • SIDS - leading cause of infant death 1 month to 1 year
  • Henoch-Schonlein Purpura: most common vasculitis of childhood
    • Hallmark: rapidly progressing palpable purpura in butt or lower extremities


Other Helpful Hints
  • 5 S’s of Innocent Murmurs: InnoSent, Soft, Systolic, aSymptomatic, left Sternal Border (note: I did NOT create this, ha)
  • THRIP = Vaccines given at 2, 4, and 6 months
    • DTaP
    • HiB
    • Rotavirus
    • IPV
    • PCV13
  • Rachitic Rosary: seen with Rickets
  • Steeple Sign: seen with Croup
  • Thumb Sign: seen with Epiglottitis
    • Barlow’s Test: tests dislocation of unstable hip by stabilizing the pelvis and flexing the hip while adducting the opposite hip and applying a posterior force
    • Ortolani Test: reduces the recently dislocated hip by flexing and abducting the hip and lifting the femoral head anteriorly into the acetabulum (feel ‘clunk’ when it enters the acetabulum)


Reflex
How to Elicit
Description
Disappears
Lying supine, turn infant’s head to side
Fencing posture with one arm outstretched
2-3 months
Support baby prone; stroke one side of back
Spine will curve toward stimulated side
Stimulus near or in mouth
Turning of head toward stimulus, sucking
Object placed in palm/sole
Flexion of fingers/toes
3-4 months
Sudden head extension
Symmetrical extension, then flexion (all limbs)
4-6 months
Infant held vertically, dorsum of feet brought into contact with surface
Lifts one foot, placing it on surface, then other
Infant held vertically, feet on surface
Legs take body weight, push against mom


  • Postural Reactions


Postural Reaction
Description
Importance
Disappears
Head Righting
Chin lift when prone
Head control
6 W-3 Months
Extension of head, trunk and legs when prone
Trunk Control
4-6 Months
Anterior Propping
Arm extension anterior when sitting
Tripod sitting
Arm extension laterally
Independent sitting
6-7 Months
Arm extension when falling
Facial protection when falling
8-9 Months
Posterior Propping
Arm extension posteriorly
Pivot in sitting
8-10 Months


American Academy of Pediatrics (AAP) - publishes guidelines for health supervision visits and the age-appropriate components of each visit



  • Blood pressure screening after age 2
  • BMI screening after age 3
  • Vision and hearing screenings

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