Here is your Final Blueprint: 90 multiple choice & 10 math

Neonate (1), Infant (5), Toddler (7), Preschool (7), School-age (5) & Adolescent (6) - G&D,
anticipatory guidance
Hospitalized child/Procedures (5)
Respiratory (8)
GI (4)

GU (3)

Cardiac (4)

Musculoskeletal (7)

Grief/Chronic (1)

Blood/Immune (6)

Endocrin (4)

Skin/Burns (3)

Neuro (5)

Cognitive/Sensory (2)

Comm Ds (2)

Medications (steroids,Iron/Vitamins, Resp meds, insulin)

Infant G and D (1-12 months)

- grasp an object at 5 months but cant let go
- pincer grasp at 11 months
- no head lag by 6 months
- crawling, pulls self to standing position by 9 months
- sitting up by 8 months
- walking assisted by 11 months, unassisted by 1 yr
- let baby signal need dont anticipate
- trust vs mistrust
Toddler G and D (12-36 months)
- by 2 yrs can walk up and down stairs
- avg wt. 27lbs, avg ht 34 inches
- by 2.5 can jump, using both feet, stand on one foot for a sec or two
- by 3 can climb stairs with alternate footing
- 18 months can throw ball overhand
- 2 yrs build towers 6 cubes, kick ball
- 3 yrs draw circles on paper
- Asks why a lot
- Concrete thinkers
- Quest for autonomy
Preschool G and D (3-5 yrs of age)
- walking, running, climbing, and jumping well established by 3 yrs
- rides tricycle, broad jumps
- skips and hops on one foot by 4 yrs
- rewards and punishment
- associative play, imaginary playmates
- thinks if they gut cut insides will pour out
- initiative, magical thinker

School-age G and D (6-12 yrs)

- industry vs inferiority need sense of accomplishment
- same sex best friends
- peer groups, associative play
Adolescent G and D (13-18)
- invincible, abstract thinkers, formal operations
- feels like everyone is looking at them
- identity, body image, peer groups
Insulins:
- rapid acting (lispro or humalog) 15 mins before meal
- short acting (regular) only one can be give IV 30 mins before meal
- Intermediate acting (NPH or lente) 18 to 26 hrs
- Long acting (lantus) 24 hr
Hypoglycemia: irritable, nervous, bad coordination, sweaty, dilated pupils
Hyperglycemia: lethargic, thirsty, confused, N and V, dehydrated, fruity breath
Alcohol and Exercise cause hypoglycemia
Hyperglycemia can occur 3-4 days before start of menstruation
Acute Glomerulonephritis caused by strep
Do not palpate Willms tumor (nephroblastoma) malignant tumor of the kidney
Nephrotic syndrome youll see fat face, edema, massive proteinuria, oliguria
LP: side lying left side, knees to chest; cold cleansing solution, after lay flat 1 hr
Decorticate: arms flexed towards core, legs extended
Decerebrate: arms extended away, legs extended (decorticate untreated leads to
decerebtate)
Menengitis: prevent with Hib vaccine; photophobic
Bacterial Menengitis: start antibiotics immediately, isolate 24 hrs after started
Encephalitis: inflammatory process of CNS, caused by mosquitos and ticks sometimes
Guillian Barre: ascending flaccid paralysis symmetrically, watch respiratory, usually
resolves in about 2 weeks

Reyes syndrome: virus related to aspirin or NSAIDs treatment during chicken pox or flu
Spina bifida: neural tube defect; prevention folic acid at least 400mg, can lead to Arnold
chari and cause hydrocephalus, latex allergy
Untreated Hypothyroidism causes mental retardation
Impetigo: staph
Cellulitis: staph
Herpes simplex: fever blisters
Herpes zoster: genital blisters
Treat fungal infections with oral griseofulvin and a zole
Diarrhea r/t infection often caused by Rotavirus
Hirschprungs disease is a mechanical obstruction of the colon, usually why dont pass
meconium within fist 24 hrs, surgery to repair
Celiac disease is gluten sensitivity (rye, wheat, barley, oats, lactose) give rice, potatoes
and corn, and fat soluable vitamins instead.
Meckels diverticulum and Intussesception: abdominal pain and currant jelly stools
Osteogenesis Imperfecta: brittle bone disease, often mistaken for child abuse
Developmental Dysplasia of the Hip: usually caused by breech birth, hear ortoloni click;
Pavlick harness to correct
Legg calve perthes disease: loss of circulation to femoral head; no weight bearing and
rest intitally, abduction and leg casts, surgery, Scottish rite brace
Wolff Parkinson white syndrome: extra conductive pathway, abalation to treat; will show
delta wave on ECG*********
Increased blood flow to lungs (CHF, right ventricular enlargement, bacterial endocarditis)
-PDA
-ASD
-VSD
Decreased blood flow from stenosis (narrowing)
-Coarctation of Aorta (widened pulse pressure)
-Pulmonary stenosis
-Aortic stenosis
-Pulmonary atresia (not compatible with life unless other defects)

Digoxin: given to increase cardiac output; therapeutic levels 0.8-2.0, watch K levels,
dont give to child if HR < 100, antidote is digibind
Rheumatic Fever: affects heart and usually after untreated strep infection; diagnose with
modified jones criteria
Kawasaki disease: cardiac related; seasonal (winter and spring)
TB: mantoux skin test read 48-72 hrs later, 10 mm is positive
Bronchiolitis: often caused by RSV, treat with synargis monthly
Peak Flow for asthma: check at least q am; one hard puff x 3, take best of those to assess
green, yellow, and red zones
Cystic Fibrosis: diagnose with sweat chloride; first suspected by meconium ileus, if
pancreatic involvement will have frothy stools, so give enzymes with food; will often see
Celiac disease
Sickle Cell: hydrate and O2 first I think
Hemophili A and B; deficiency in factors VIII and IX; Von Willebrand is recessive and
seen in girls
Dehydration: weight loss is best identifier
Esophageal atresia: surgical emergency, post op is sterile water for first feeding
Pyloric stenosis: projectile vomiting, surgery needed, can vomit 24-48 hrs after surgery
and is normal
Cleft lip and palate: no straws, no hard candies, surgery on lip first few months, surgery
on palate 3-9 months
If in skeletal traction check for infection by temperature
Casts: watch for compartment syndrome, cool hairdryer for itch, palms until dry, elevate
above heart, pack in ice for swelling
Scoliosis: lateral curvature, bend over and ull see it; brace doesnt correct condition
Chicken pox: contagious until vesicles crust
Fifths disease (HPV): slapped face
Scarlet fever: red strawberry tongue; pinhead lesions everywhere but face

Dont give pregnant MMR, Varicella, or Hep B

Cherry red lips with carbon monoxide poisoning, give 100% O2
Mannitol decreases osmotic pressure in neuro patients
Caf au lait spots may lead to neurofibromatosis
Infectious mononucleosis: principal cause is herpes like Epstein Barr virus
Most common STDs are Chlamydia and HPV
DPT injection at 2,4,6,15-18,4-6yrs
B-thalassemia: iron chelation therapy and blood transfusions
Leukemia: overproduction of immature WBCs
Frieds rule: (months) x/150 X avg adult dose
Clarks rule: (weight lbs) x/150 X avg adult dose
Youngs rule: (yrs) yrs/ 12 X avg adult dose
BSA rule: BSA in meters sqd/1.7 X avg adult dose