Полезные материалы за все 6 курсов / Учебники, методички, pdf / Kaplan Pediatrics USMLE 2CK 2021

Chapter 4 λ Development

Table 4-2. Developmental Milestones

Chapter 4 λ Development

Possible Abnormalities

You must take into account the number of weeks of prematurity to assess development appropriately, i.e., per the preterm age, NOT chronological. For instance, a 6-month-old baby born at 32 weeks (i.e., 2 months preterm) must be assessed at 6 – 2 = 4 months CORRECTED AGE. Do this until chronological age 2 years, then consider delays to be true.

•If there appears to be a language delay, first consider conductive hearing loss. While all babies receive hearing testing within the first month of life, that is for congenital sensorineural hearing loss. Over the first year of life, conductive hearing loss may occur from repeated ear infections.

•If there is a lack of development or regression of language skills with impaired social interaction, restricted activities and interests and stereotypic behaviors, consider autistic spectrum disorder. Onset of abnormal findings must occur age <3 years.

–After a complete H and P with neurologic exam and development testing, the first step is to perform an autism screening questionnaire. If you feel the diagnosis is likely, the next step is to refer to a specialist in this area.

•Delay is defined as ≥1 skills significantly below average, i.e., developmental quotient

(developmental age/chronological age x 100) is <75. When you find this, you must first look for a possible reason, and the child will need developmental therapy in ≥1 areas.

Learning Objective

Solve problems concerning eating disorders, elimination disorders, and sleep disorders

EATING DISORDERS

Pica

•Repeated or chronic ingestion of non-nutritive substances, e.g., paint, dirt

•After year 2, needs investigation

•Predisposing factors

–Intellectual disability and lack of parental nurturing

–Also with family disorganization, poor supervision, and psychologic neglect

•More common with autism, brain-behavior disorders, and low socioeconomic status

•Increased risk for lead poisoning, iron deficiency, and parasitic infections

ELIMINATION DISORDERS

Enuresis

A 7-year-old boy has problems with bedwetting. The mother says that during the day he has no problems but is usually wet 6 of 7 mornings. He does not report dysuria or frequency, and has not had increased thirst. The mother also says that he is a deep sleeper.

•Voluntary or involuntary repeated discharge of urine after a developmental age when bladder control should be present (most by age of 5 years); there are 2 types

•Primary:

–No significant dry period; most common and usually nocturnal (nocturnal enuresis)

–Hyposecretion of ADH and/or receptor dysfunction

Chapter 5 λ Behavioral/Psychological Disorders

•Management

−Clear impacted fecal material (with mineral oil or laxative) but avoid long-term laxative use

−Concomitant behavioral management

−Regular postprandial toilet-sitting

−High-fiber diet

−Familial support for behavior modification

−Group or individual psychotherapy

Clinical Recall

A concerned mother brings her 4-year-old son to the physician for evaluation of nocturnal enuresis. The boy has never had a significant dry period. He has regular bowel movements without constipation or encopresis. What is the most appropriate next step?

A.Encourage the mother to use a bell and pad alarm system

B.Order a urinalysis to assess for infection

C.Punish the child whenever he wets the bed

D.Refer the mother and child to psychotherapy

E.Reassure the mother that this is normal for the boy’s age

Answer: E

SLEEP DISORDERS

Parasomnias

Parasomnias are episodic nocturnal behaviors that often involve cognitive disorientation and autonomic and skeletal muscle disturbance

•Associated with relative CNS immaturity

•More common in children than adults; abate with age

Immunizations 6

Chapter Title

Learning Objectives

Define active immunization

Describe different routes of immunization for specific routine vaccines

A 6-month-old patient is being seen for routine care. The baby is doing well, and physical examination, growth, and development are normal. The mother states that after the last set of immunizations the baby had a temperature of 39.4 C (103 F) and cried for 2 hours but was consolable. What is your advice to this mother before administering the next set of immunizations?

ACTIVE IMMUNIZATIONS

Table 6-1. Classification of Vaccines

Vaccine Rules

For stimulation of an adequate and persisting antibody response, 2 or more doses are usually required. In general, vaccines from different manufacturers are interchangeable.