Overview of pediatric and pregnancy pearls review for boards and wards! ANCC and AANP high yield topics by dual boarded, seasoned faculty Jennifer Klimek Yingling
Nitrofurantoin (Macrobid) is no longer recommended in the 1st and 36 weeks or later. UptoDate recommends Cefpodoxime, Augmentin, and Fosfomycin for safety in pregnancy.
Scoliosis: at minute 26:33 you indicate to refer to ortho if a curvature of 10 degrees in Scoliosis. However, Leik 4th edition page 514 states to monitor all curvess< 20 degrees. Bracing is indicated with curves 20-40 degrees and Surgery for all curves >40 degrees. The American Academy of Pediatrics recommends screening for scoliosis to be performed yearly; referral to an orthopaedic surgeon is recommended in patients whose spinal curves exceed 20° on standing posterior-anterior spinal radiographs or in patients with atypical history, physical or radiographic
Trendlenburg Test: assess weak hip abductor muscles. While many causes in pediatrics we are assessing for Hip Dysplasia, LCP and SCFE. Positive test is when pelvis drops on UNAFFECTED SIDE
Better way to remember Barlow and Ortolani is: Bar: going out: Hip is dislocated with Adduction Out: (Ortolani): Once you have been out-go home! Reduces femoral head back into acetabulum with Abduction of hip Barlow and Ortolani is not a specific test after 3 months of age. Other signs such as + trendelenburg test and Galezzi test is seen in those older kids
VUR: Impt to note that American Academy of Pediatrics (AAP) recommends routine screening renal bladder ultrasound (RBUS) after a first febrile urinary tract infection (UTI). VCUG would NOT be indicated unless abnormal RBUS or suspicion for genitourinary abnormalities. Otherwise VCUG is indicated with recurrence of febrile UTI. New guidelines from the American Academy of Pediatrics do not recommend routine use of voiding cystourethrography (VCUG) after the first urinary tract infection in febrile infants and children aged 2 to 24 months.
Impt to note as other review courses have that Prozac is 1st line and Zoloft 2nd line. SSRI tx requires frequent monitoring as black box warning on medications report increased risk of Suicide in 1st 1-2 months of tx.
Intoeing or Metatarsus Adductus is caused by metatarsus adductus, internal tibial torsion, and femoral anteversion. The AAP recommendations: If your baby's intoeing persists after 6 months, or if it is rigid and difficult to straighten out, your doctor may refer you to a pediatric orthopedist, who may recommend a series of casts applied over a period of 3 to 6 weeks. The main goal is to correct the condition before your child starts walking.
Naegels rule question is wrong. It should be 10/15/2020. You add a year AFTER you've subtracted the 3 months, which would be October 2019 in this example, + 1 year = 2020.
When to refer according to AAP: Any misalignment of eyes (intermittent or constant) in children after the age of 4 months or constant misalignment of eyes at any age even before 4 months should be evaluated. ► A difference of 2 lines or greater between eyes should prompt a referral. Any acuity ≤ 20/50 should be evaluated.
At 10:06 in the video you state that Lazy eye or Amblyopia and strabismus are the same. However, they are two different conditions. Strabismus is the most common cause of amblyopia Very simply, Strabismus, the medical term for "crossed-eye", is a problem with eye alignment, in which both eyes do not look at the same place at the same time. Amblyopia, the medical term for "lazy-eye", is a problem with visual acuity, or eyesight. Many people make the mistake of saying that a person who has a crossed or turned eye (strabismus) has a "lazy-eye," but lazy-eye (amblyopia) and strabismus are not the same condition. Amblyopia is detected by assessing the visual acuity of each eye. Strabismus is detected by using the corneal light reflex test and the cover test.
The US Food and Drug Administration (FDA) places Metformin in category B: 'Animal reproduction studies have failed to demonstrate a risk to the fetus. Metformin may be used in pregnancy. Treatment for GDM: Lifestyle, if levels continue to be high then insulin. If unable to use insulin or refuses insulin, then Metformin is approved for use
Nitrofurantoin (Macrobid) is no longer recommended in the 1st and 36 weeks or later. UptoDate recommends Cefpodoxime, Augmentin, and Fosfomycin for safety in pregnancy.
Scoliosis: at minute 26:33 you indicate to refer to ortho if a curvature of 10 degrees in Scoliosis. However, Leik 4th edition page 514 states to monitor all curvess< 20 degrees. Bracing is indicated with curves 20-40 degrees and Surgery for all curves >40 degrees.
The American Academy of Pediatrics recommends screening for scoliosis to be performed yearly; referral to an orthopaedic surgeon is recommended in patients whose spinal curves exceed 20° on standing posterior-anterior spinal radiographs or in patients with atypical history, physical or radiographic
Trendlenburg Test: assess weak hip abductor muscles. While many causes in pediatrics we are assessing for Hip Dysplasia, LCP and SCFE. Positive test is when pelvis drops on UNAFFECTED SIDE
Better way to remember Barlow and Ortolani is:
Bar: going out: Hip is dislocated with Adduction
Out: (Ortolani): Once you have been out-go home! Reduces femoral head back into acetabulum with Abduction of hip
Barlow and Ortolani is not a specific test after 3 months of age. Other signs such as + trendelenburg test and Galezzi test is seen in those older kids
VUR: Impt to note that American Academy of Pediatrics (AAP) recommends routine screening renal bladder ultrasound (RBUS) after a first febrile urinary tract infection (UTI). VCUG would NOT be indicated unless abnormal RBUS or suspicion for genitourinary abnormalities. Otherwise VCUG is indicated with recurrence of febrile UTI. New guidelines from the American Academy of Pediatrics do not recommend routine use of voiding cystourethrography (VCUG) after the first urinary tract infection in febrile infants and children aged 2 to 24 months.
Impt to note as other review courses have that Prozac is 1st line and Zoloft 2nd line. SSRI tx requires frequent monitoring as black box warning on medications report increased risk of Suicide in 1st 1-2 months of tx.
Intoeing or Metatarsus Adductus is caused by metatarsus adductus, internal tibial torsion, and femoral anteversion. The AAP recommendations: If your baby's intoeing persists after 6 months, or if it is rigid and difficult to straighten out, your doctor may refer you to a pediatric orthopedist, who may recommend a series of casts applied over a period of 3 to 6 weeks. The main goal is to correct the condition before your child starts walking.
Naegels rule question is wrong. It should be 10/15/2020. You add a year AFTER you've subtracted the 3 months, which would be October 2019 in this example, + 1 year = 2020.
When to refer according to AAP:
Any misalignment of eyes (intermittent or constant) in
children after the age of 4 months or constant misalignment
of eyes at any age even before 4 months should be evaluated.
► A difference of 2 lines or greater between eyes should prompt
a referral. Any acuity ≤ 20/50 should be evaluated.
At 10:06 in the video you state that Lazy eye or Amblyopia and strabismus are the same. However, they are two different conditions. Strabismus is the most common cause of amblyopia
Very simply, Strabismus, the medical term for "crossed-eye", is a problem with eye alignment, in which both eyes do not look at the same place at the same time. Amblyopia, the medical term for "lazy-eye", is a problem with visual acuity, or eyesight. Many people make the mistake of saying that a person who has a crossed or turned eye (strabismus) has a "lazy-eye," but lazy-eye (amblyopia) and strabismus are not the same condition.
Amblyopia is detected by assessing the visual acuity of each eye. Strabismus is detected by using the corneal light reflex test and the cover test.
The US Food and Drug Administration (FDA) places Metformin in category B: 'Animal reproduction studies have failed to demonstrate a risk to the fetus. Metformin may be used in pregnancy.
Treatment for GDM: Lifestyle, if levels continue to be high then insulin. If unable to use insulin or refuses insulin, then Metformin is approved for use