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Pediatrics Flashcards

1
Q

Measles post-exposure prophylaxis and outbreak control

A

1- time of exposure
2- contraindications ( Pregnancy, immunodeficiency, <6m )

  • if within 3 days: MMR vaccine
  • if >3 days and <6 days OR CIs: Immunoglobulin
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2
Q

Meningitis in neonatal period treatment?

A
  • Ampicillin + gentamicin + 3rd generation cephalosporin
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3
Q

Most common organism in neonate meningitis?

A
  • Group b streptococcal, E coli, Listeria
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4
Q

Neonatal hyperbilirubinemia

A
  • Common
  • Most cases are benign

Definition: total serum bilirubin above 5 mg/dl

Pathophysiology of physiological neonatal hyperbilirubinemia: in healthy newborn, unconjugated bilirubin transiently elevated during day 2 - 5 after delivery, due to turnover of fetal erythrocytes, and Usually return to normal over 1-3 weeks without intervention or adverse effects

Neurotoxicity: 1/10,000 inftants, symptoms include hyper/hypoTonia, back and neck arch, irritability, high pitch crying. This called acute billirubin encephalopathy. Most cases fully resolve but some can progress to kernicterus. ( Early: sleepiness and decrease alertness, poor sucking and feeding, hyperreflexia, hypotonia. Intermediate: Irritability, Hypertonica, arch, pitch. Advances: Pronotar spasm of upper extremities, apnea, coma

  • No clear correlation between bilirubin level alone and risk of neurotoxcitiy. Risk factors: GA<38w. Hemolytic disease of newborn. G6PD. Albumin <3. Sepsis. Asphyxia. Acidosis. Clinical irritability in the past 24 h

Prevention: Screen all mother 28 weeks for Rh(D) status and ABO blood group.

Kernicterus: IRREVERSIBLE effect of bilirubin toxicity. 1/100,000 ( cerebral palsy, hearing loss, gaze paralysis, dental dysplasia, developmental disorders)

Hyperbilirubinemia examination: EVERY 12 Hrs from birth until hospital discharge. Jaundice usually not obvious in darker skin tone and clinician should check under tongue and sclera.

Bilirubin measurement: Transcutaneous bilirubin or Total serum bilirubin. Universal screening of newborns 35 GA. At 1-2 days of life or before if discharged sooner.

  • if signs of acute bilirubin encephalopathy even if TSB doesn’t exceed phototherapy > exchange transfusion
  • Risk of phototherapy:
    Decrease exchange transfusion rate, but not show to decrease incidence of kernicterus. Short term SE is diarrhea and temp instability. Long term is increase seziure risk specially in male, and small risk of leukemia, renal and hepatic cancer. These risk highlight the importance to initiate phototherapy only in newborn excees 2022 AAP Threshold

Should decreased 0.5 mg per hour after initiation of phototherapy. If not occur. Hemolysis should be suspected for additional lab investigations if not done already.

There is a criteria for home phototherapy

BREAST FEEDING, AT LEAST 8-12 PER DAY, WITH brief interruption of phototherapy up to 30m at time to promote breast feeding.

Discontinue phototherapy when TSB at least 2mg less than phototherapy threshold

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5
Q

Well baby versus well child visit?

A

Baby: routine visits 2m-2y
Child: annually for 2-18 years

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6
Q

Microopthalmia main differntial?

A

Congenital Rubella synrome

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7
Q
  • When does assessment for Head circumference start and ends?
  • When does BMI start?
A

Birth till 2 years

BMI start at 2 years

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8
Q

Weight loss and doubling in infants?

A
  • 10% loss in the first week of life “due to elimination of ECF”
  • Regained by 2 weeks old
  • infant should double up their birthweight by 6 months. And TRIPLE by 1 year
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9
Q

Corrected age of prematurity?

A

Correct only if chronological age is less than 37 weeks

How to corrected?; 40 - gestational age at birth = X

Assessed by 6months: 6 - X

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10
Q

When to stop corrected age?

A

2 years

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11
Q

Short stature

Bone age is equal to Chronological age

A

Growth velocity normal: Familial short stature (no delayed puberty in family) - skeletal dysplasia - Rickets

Growth volecity decreased: Chromosomal or genetic disorders “ down, turner “

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12
Q

Short stature

Bone age is LESS than Chronological age

A

Growth volecity is normal: Constitutional growth delay ( family history of delayed puberty )

Growth velocity is decreased: Growth hormone deficiency - OR - Psychosocial and Endocrine disorders and Chronic diseases

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13
Q

Short stature

Bone age is MORE THAN Chronological age

A
  • Growth volecity usually initially increased but short adult

Normal: obesity, familial tall stature

Precocious puberty
CAH
Hyperthyroidism
Exogenous androgenic steriods

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14
Q

Short stature definition

A

Less than 5th percentile of height for age
Or more than 2 SD below the mean in height

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15
Q

What decrease first in Malnutrition versus Growth hormone defiency

A

Malnutrition: Weight first
GHD: Height first or same time as weight

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16
Q

RED FLAGS FOR DEVELOPMENTAL MILESTONES?

A

12m: No Babbling- Pointing - Gesture

16m: No single word

24m: No two-word phrases

At any age: loss of language or social skills

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17
Q

Reflexes and disapear?

  • Stepping reflex (remember feets)
  • Rooting/sucking reflex (remember time of introduction solid food)
  • Palmer and Planter grasps ( remember 3+3 )
  • Asymmetrical tonic reflex
  • Moro reflex
A
  • Stepping : 2m
  • Rooting/sucking: 4m
  • Palmer grasp: 3m
  • planter grasp: 6m
  • Asymmetric tonic reflex: 4m
  • Moro reflex: 6m
18
Q

When cow milk can be introduced?

A

After 1 year
To avoid risk of IDA

19
Q

Galactosemia, congenital lactose defiency, and cow milk allergy?

A

Avoid lactose free formula

Go for soy based formula

Lactose free has no advantage over cow milk formula, EVEN for acute gastroenteritis or colic

20
Q

When to stop formula?

A

No indication to continue formula beyoned 1 year age

1 year age is time for normal Cow milk

21
Q

Iron supplements

A

1mg/kg/day

Starting from 4 months in breast feeding, or partially breast feeding (>50% of daily feed) till introduction of fortified iron food at about 6 months

22
Q

Physical activity recommendations?

A

3-5 years: physically active throughout the day

6-17 years: 1 hour of moderate to vigorous activity

23
Q

Killed or live vaccine?

A

All Viral vaccine are live except HI HI: Hepatitis A and B, IPV, inactivated Influenza

All bacterial vaccine are killed except TB: Typhoid, BCG

24
Q

Vaccination schedule mnemonic

0m

2m

4m

6m

9m

12m

18m

24m

4-6y

A

Hey Baby 0

DR Handsome HIP 2

DR Handsome HIP 4

Really BaD Hip Hop 6

M&M 9

Old M&M Piece 12

Huda And Hasan MOVeD 18

HA! 24

MOVeD 4-6

25
Q

Contraindication And Precautions to all Vaccines

A

Live: pregnancy and immunocompromised

All: CI (urticaria or anaphylaxis), precautions (moderate to severe illness with or without fever)

26
Q

Dtap CI and Precautions?

A

CI:
- Encephalopathy within one week of Dtap administration, not caused by other cause

Precautions:
- GBS <6 weeks after previous dose
- Progressive neurological disorder

27
Q

MMR CI and precautions

A

CI
- pregnancy or known immunodeficiency

  • Precautions: 11month or less of antibody containing blood product receiving, thrombocytopenia, need TB testing
28
Q

Rota virus CI and precautions

A

CI:
- Severe combined immunodefiency
- intusussception

Precautions:
- Chronic GI disease
- bladder extrophy
- spina bifida

29
Q

Varicella CI and precautions

A

CI:
Immunodeficiency or pregnancy

Precaution:
AB containing blood product within 11m
Use of aspirin (rey syndrome)
Specific antiviral drugs 24h before vaccination “and avoid 2weeks after vaccination”

30
Q

AAP recommendation for hearing screening

A

1 month of age

PLUS periodic hearing risk assessment throughout 4-10 years

31
Q

AAP, AAFP, and USPSTS recommendation for visual screening

A

Amblyopia, starbismus, and visual acuity should be screened younger than 5 years of age ( usually between 3-4 years )

Then every 1-3 years throughout childhood and adolescent ( insufficient evidence in USPSTF )

32
Q

Dentist referral?

A

Fluride ar 6m
Referral at 1y

33
Q

Breastfeeding recommendations and benefit

A
  • exclusive in the 6m, with food till 1 year, and after as desired
  • colustrum: IgA and protein, lactoferrin
  • mature milk: by day 5, 500ml/d

For infant, decrease:
Infection
Sudden infant death syndrome
Decrease risk of NEC

For children:
Decrease type2 dm, obesity, increase IQ, decrease risk of dental occlusion

For mothers:
Decrease PPH, decrease Ovarian, breast, and endometrial cancer, central obesity and metabolic syndrome

34
Q

Contraindications for Breast Feeding

A

Infant factor:
- Type one galactosemia

Maternal factor:
- HIV
- Active herpes in the breast
- on Chemo or radiotherapy
- active drug or alcohol disorder
- untreated TB or Varicella
- human T-cell lymphotropic virus type 1 or 2

35
Q

Storage of breast milk?

A

Freezer:
Up to 6 month, 12m is okay

Refigator:
Up to 4 days

Room temperature:
Up to 4 hours

If thawed “previously frozen”
Never refreeze it
1 day at refrigerator or 1-2h room temp

If leftover in the bottle: 2h then dispose

36
Q

How to know the adequacy of beast feeding?

A
  • amount of urine, 5-6 times/day at least
  • amount of stool and frequency
  • weight gain, 15-20 g / day in the first month
  • sleep after feed, and breast is lighter
37
Q

When pica needs to be investigated?

A

At two years and assess risk of IDA, lead poisoning, parasitic infection

38
Q

Causes of secondary enuresis (dryness for 6m)

A
  • Psycosocial
  • DM
  • UTI
  • Constipation
    More in girls and the primary more in boys
    Needs U/S and urodynamic study
39
Q

Swimming lessons at age of?

A

1 year

40
Q

Seat belt in children

A
  • up to 2y: rear
  • 2y to 8y: forward
  • 8 year: seat belt

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