Exam 1 Flashcards
(208 cards)
1
Q
Term used for features that appear abnormal
A
Dysmorphic features.
2
Q
What is plagiocephaly?
A
Flat head syndrome - uncorrected torticollis can lead to this.
3
Q
If the fetus has measurements that are symmetrically decreased, then it suggests a __________ versus if the head circumference is preserved and other areas are small that suggests _______
A
Chronic exposure (maternal smoking or drug use), congenital infection, metabolic disorder or chromosomal abnormality.
Abnormalities occurring LATER in pregnancy like uteroplacental insufficiency.
4
Q
Small for gestational age is below ______ and large for gestational age is above _____
A
10th percentile
90th percentile
5
Q
Glucose screening is recommended for these 3 types of newborns:
A
- Large or small for gestational age
- Born to diabetic mothers
- Late preterm (34-36 6/7)
6
Q
What is the average head circumference at 40 weeks gestation?
A
14in (35cm) with a range of 13-15 in.
7
Q
Normal HR, RR and SBP for 40wk newborn
A
HR 120-160
RR 40-60
SBP 60-90
8
Q
What is Caput succedaneum and is it bad?
A
Scalp edema, pitting, not limited by suture lines and resolves w/in 48hrs. Not serious.
9
Q
What is cephalohematoma, when is it more common and what is it a risk factor for?
A
Injury to a blood vessel in subperiostial layer. Limited by suture lines.
Forcep or vacuum deliveries.
Risk factor for jaundice and sepsis.
May worsen over 48 hours and take 3-4 months to resolve.
10
Q
What is the CHARGE acronym and what is it associated with?
A
Coloboma of eye (gap or defect in structure of eye primarily iris), Heart defects, Choanal Atresia, Retraction of growth and/or development, Genital and/or urinary abnormalities, Ear abnormalities and deafness
11
Q
T/F: dysconjugate gaze is normal in the first 2-3 months of life.
A
True
12
Q
What is the difference between dacryostenosis and conjunctivitis?
A
Dacryostenosis is a blocked tear duct which causes yellow, sticky secretions to accumulate with normal conjunctiva, but conjunctivitis has red irritated conjunctiva.
13
Q
Newborns with pre auricular pits or cup ears should have a renal ultrasound if:
A
Other malformations/dysmorphic features, teratogenic exposures, family hx of deafness or maternal history of GDM.
14
Q
What is choanal atresia?
A
One or both of the nasal airways are narrowed or blocked.
15
Q
What could the following newborn cardiovascular findings indicate?
Weak pulses
Bounding pulses
Single second heart sound
Grade 3 or higher murmur
Hepatomegaly
A
Weak = poor cardiac output (aortic stenosis)
Bounding = high CO (PDA)
SS - truncus arteriosus, hypoplastic left heart
Murmur - pathogenic
Hepatomeg - L HF.
16
Q
T/F: the newborn first heart sound should be single and the second heart sound should be split.
A
True.
17
Q
AD, AR and X-linked conditions are _________
A
Mendelian single-gene conditions
18
Q
40% of pediatric genetic conditions have an unknown cause
20-25% are environmental and genetic
10-15% are chromosomal during embryogenesis
2-10% are single gene abnormalities
A
19
Q
Types of environmental triggers for genetic anomalies
A
Maternal disease/sickness
Uterine/placental abnormalieties
Drug/chemicals
20
Q
1/33 are born with a genetic defect, and 2-3% of genetic conditions are identified at birth. By age 7, 8-10% of children may have 1 or more malformations.
A
21
Q
Difference between somatic and germline mutations?
A
Somatic - single cell - cancer
Germline - egg/sperm, passed on
22
Q
What Trisomy’s are compatible with live births?
A
13, 18 and 21
23
Q
What are the red flags that may indicate a genetic condition
A
Multiple family members with similar/related conditions
AD inheritance
Early age of disease onset
Occurrence of disease in less-often-affected sex
Multi-focal
24
Q
Difference between penetrance and variability
A
Penetrance is the “visible” abnormality as a percentage
Variability is differences in disease expression
25
If the trait appears in every generation, and offspring have a 50% chance of being affected. M+F affected equally and M->M transmission is possible. What type of genetic condition?
Autosomal Dominant
26
What type of genetic conditions are “spell check” conditions such as Apert, Marfan, neurofibromatosis, waarenburg)
Autosomal Dominant
27
This genetic condition appears in siblings but not in parents or offspring (skipping generations), M+F equally affected. 25% chance of being passed on in consanguineous carrier parents
Autosomal Recessive.
28
Autosomal recessive conditions often affect _________ pathways
Enzyme
29
Virtually all mitochondria are supplied by the ________
Oocyte
30
CF, SSD, Tay-Sachs, PKU, CAH, Troyer Syndrome are examples of ______ disorders
AR
31
If all daughters of affected males are carriers and the condition is only expressed in males, then it is a
X-linked genetic conditons
32
1/3 of x-linked conditions are denovo, and 2/3 are inherited from mother.
33
Is it possible for a F to have an x-linked condition expressed? In what 3 situations?
Yes. If the Dad is affected an mom is carrier OR if they only have 1X (Turner’s) OR x-autosomal translocation
34
What are some examples of x-linked genetic disorders
Hem A+B, Duchenne and Becker MD, color blindness, G6PD
35
Trisomy 13 is called Patau syndrome.
Trisomy 18 is called Edward’s syndrome.
36
How are mitochondrial diseases inherited?
Affected F transmit to all children. Affected M cannot transmit.
37
What is the difference between deformation and malformation?
Deformation - mechanical force causing abnormal shape (ie club foot)
Malformation - structure defect with very early onset (ie neural tube defect)
38
What is a teratogen an example of? _______ what is the definition?
Disruption - structural defect interfering with originally normal development.
39
2vessel cord has a 7x increased risk for congenital abnormalities and especially cardiovascular.
40
What are some of the most common abnormalities associated with chromosomal defects?
2 phalanges, a single palm crease and dysmorphic ears.
41
What did public Law 110-204 do and what year was it passed in?
Newborn Screening Saves Lives Act of 2008
Amends Public Health Services act to facilitate creation of Federal guidelines
42
NBS Saves Lives Reauthorization (2014). Parental consent required b4 blood could be used in federally-funded research.
43
Read through cases at the end of Genetics PPT
44
NIH GeneReviews - the “google” of genetic disorders
45
What is the pediatric assessment triangle? (PAT)
Appearance, WOB and circulation
46
Some additional H+P during Peds appointment:
Who is the informant and are they reliable?
Birth (gestational age, birth weight, how long stayed in hospital) and Developmental history (missing milestones?)
Imms and prev exams
Faces pain scale
Eat, drink, pee, poo, play, sleep and activity
Home meds in safe locations esp cannabis (gummies)
ASQ/M-CHAT
Potty training - urine and stool and overnight
Comparison with parents and siblings
School performance
Social Media
47
What are the 3 main social determinants of health (SDOH)
Access/transportation to appointments and pick up meds
Food security
Housing security
48
What questions can you ask about peds diet?
Breast milk or formula? How often and how much
Vitamin supplements
Solid food - when and what
Appetites
Snacks, juice and soda.
49
Sacral cleft is usually a sign of issues with the thoracic spinal cord while a gluteal cleft may be a sign of tethered cord/cauda Aquina or future development of pyelenidal cysts
50
The Fetal circulation is ____-resistance and a _____ rate of metabolism.
low
High
51
The PaO2 of a fetus is 40. Are they hypoxic?
No because HgF is shifted to the L on the curve so there is more dissociation to the tissues. Sats are still 100%
52
What may potentially develop in late preterm infants born via C-section with NO LABOR?
Delayed Fluid Resoprtion
53
What needs to happen prior to birth for a GOOD first breath?
The pulmonary pressures need to DROP.
54
What are the 3 “holes” in the pediatric circulatory system?
Ductus venous - bypass liver and go to heart
Foramen ovale - LA -> RA
Ductus arteriosus - pulmonary arteries -> descending aorta.
55
After birth, the newborn needs to ______ their _____ fetal SVR and ______ their ______ fetal PVR
Increase , low
Decrease, high
56
CROTCHES
CMV
Rubella
Other (zika)
Toxo
Chicken pox
HIV, HSV, HBV
EBV
Syphilis
57
TTTS happens in monozygotic twins
58
What is the new term for Mongolian spots?
Dermal melanocytosis
59
Indirect vs direct bili
Indirect (UNconjugated) - I and U are vowels. Hgb catabolized to bilirubin which binds to albumin and goes to the liver.
Direct (Conjugated) - DC are consonants. In the liver, the UNconjugated bili is conjugated which means it becomes water soluble and go to GI tract via common bile duct and excreted in stool.
60
Indirect bili should peak at no more than _____ by day __ of life
12
3
61
8-12 breast feedings/day for first few weeks of life or 1-2 oz of formula every 2-3 hours.
62
A high DIRECT bili (over ___) can signify a blockage in the bile duct (biliary atresia or “pathological” jaundice)
2
63
MILESTONES 0-18 months!! (12-18 on Exam 1 and 0-9 on Quiz)
64
How many well-baby visits in the 1st year?
7
3-5 days, 2 weeks, 2, 4, 6, 9 and 12 months
65
When does autism screening start?
18 and 24 months
66
During health supervision visit is (AKA well-child exams), what are the 4 main objectives?
Disease Detection
Disease Preventino
Health Promotion
Anticipatory Guidance
67
6 components for each well-child visit: and what is the FIRST priority?
1. History (parental concerns) and ROS
2. Surveillance of Development
3. Screening tests and risk assessments
4. Comprehensive Physical Exam
5. Immunizations
6. Anticipatory Guidance
PARENTAL CONCERNS are the first priority!!
68
When is the peak weight loss and what is normal? When should they return to birthweight?
5th day of life
10-12%
7-10 days of life or definitely by the 2week check up.
69
When should vit d supplementation start for breastfed babies?
Within first days of life.
70
Risk factors for jaundice:
<38 weeks, maternal blood type, direct AB test (DAT) positive, cephalohematoma, significant bruising, infant of diabetic mother, East Asian race, older sibling who required phototherapy.
71
How do you screen for congenital heart defect and what do you do if the screening is positive?
Predictable (R hand) and post ductal (L) hand sats at 24hrs after delivery (should not be more than 3% difference). If abnormal, then do diagnostic echo
72
How do you screen for hyperbilirbinemia and what do you do if the screening is positive?
transcutaneous levels. If they are over 15, then obtain serum bili.
73
Do the Barlow maneuver first: ADduct the hip while applying downward pressure on knee.
then do Ortolani maneuver: flex knee and hips to 90* and with index finger, place anterior pressure on greater trochanters abducting with thumbs. Best to do one leg at a time.
74
A fever during the first 2 months of life is an emergency - go in right away!
75
Main components of 2 week well
Return to birth weight, repeat NBS, evaluate maternal/paternal well-being (postpartum depression) and repeat PE.
76
8-12 feeds/day
16-24oz/day
6-8 wet diapers/day with multiple yellow seedy stools.
77
Newborn RSV vaccine - administer when?
Mom at least 14 days prior to birth, OR to baby before they leave. OR Before baby reaches 5g.
78
What is the normal timeline for umbilical cord to fall off? Care?
10-21 days. No alcohol, keep dry, diaper folded down, no submersion until healed. If >3 weeks, consider urachal anomaly or leukocyte adhesion deficiency.
79
What is the test for a positive hip dysplasia screen?
Hip US
80
T/F: parents should pretreat or give Tylenol after vaccines
False. If pt is uncomfortable or runs a fever than you can give, but some evidence show it may decrease immune response.
81
If you notice torticollis - what should you do?
PT referral, neck stretches with diaper changes.
82
No Motrin until after ______ mo.
6 mo
83
4 mo feeding:
6-10x/day
Formula 30-32oz/day.
84
What should weight be at 4mo visit?
Birth weight doubled.
85
6mo feeding
Breast 5-6x daily
Formula 30-32oz/day with solids1-3x/day
86
At 6mo, no more Barlow/ortalani and more _______
Thigh folds/gluteal folds.
87
Start iron supp at ____ mo.
6 for babies who are not starting iron fortified foods.
88
Imms at 9mo?
None! But check to make sure they got everything so far!
89
When should testes be fully descended.
12mo.
90
What screenings happen at 12 mo?
Lead and anemia.
91
What is the difference between surveillance and screening?
Surveillance: watching for things to be occurring that arent’ or noticing things that are there that shoulddn’t be there
Screening: using a validated tool to conduct screening.
92
Global developmental delay, intellectual disability/intelectual development disorder, communication disorders (language, speech, social communication, unspecified), Autism spectrum disorder and AD/HD are the top 5 categories of __________ (surveillance/screening?)
Surveillance.
93
Surveillance leads to screening.
94
Asking about milestones is an example of _______
Surveillance
95
M-CHAT screens for ____ and is administered at ______ visits.
ASD
9,18 and 30mo.
96
Survey of well-being of young children (SWYC).
Puts it all together WITH social context (Edinburgh), emotional behavioral, and milestones/development, POSI along with family questions.
97
POSI is validated for age _____. A positive result would be ____
16-36 mo
3 or more points in last 3 columns (out of 7).
98
Major vs minor features of genetic syndromes
Major - a single feature that is highly specific with a genetic syndrome
Minor - a group of features that are specific with a genetic syndrome. They may be present just as genetic variants. The more minor features, the more possibility of a genetic syndrome.
99
Diabetic kids must have annual eye exam
100
Patients should go to a pediatric ophthalmologist if:
They are non-verbal or there is developmental delay, or unable to cooperate.
101
When is best visual acuity achieved in kids?
20/20 achieved at 5-6yo
102
Myopia is
NEARsightedness (short-sighted). Typical onset around 8.
103
Hyperopia is
Farsightedness - blurred close objects.
104
If patient tips head back and looks down nose or moves closer to the TV what might they have?
If patient squints when you point at something across the room?
Hyperopia - farsightedness
Myopia - nearsightedness.
105
What is amblyopia? Prognosis? Dx by?
Unilateral or bilateral reduction in central visual acuity.
Untreated can lead to blindness or loss of depth.
With corneal light reflex, cardinal fields exam or cover/uncover.
106
Strabismus
Misalignment of visual axes of 2 eyes.
“Lazy eye”
107
T/F: you can squeeze a stye but not a chalazion
True. Stye is infx of eye lash Zeis gland
Chalazion is infx of meibomian gland.
108
Horner has _____ eye lid and _____ pupil and _____ skin
Droopy
Constricted
Dry
109
Strep pneumoniae, M. Catarrhalis, haemophilus influenza B can be associated with
URI AND Dacryocystitis
110
Allergic conjunctivitis tx
Antihistamines w/ or w/out vasoconstrictor (olapatadine, naphazoline/antazoline)
111
What should you suspect with repeated episodes of conjunctivitis, iritis or episcleritis
Suspect mucocutaneous disease such as erythema multiforme (SJS), reiter syndrome, Lupus, JRA, IBD, ankyllosingn spondylitis, psoriatic arthritis, Kawasaki disease.
112
What condition is a “peri-limbic flush” associated with?
Uveitis
Anterior uveitis (iritis)
Powterior
Intermediate
Needs urgent slit lamp exam.
113
Preseptal cellulitis - staph or strep.
114
Children less than 3 with Preseptal cellulitis can be associated with _____
Bacteremia.
115
Orbital cellulitis is almost always from _______
Continuous sinus infection (usually ethmoid)
116
Orbital cellulits: describe!
Next steps?
Frank pus in orbit (abscess)
Swollen edematous eye, eye pain, bulging, pain with EOM, diplopia, reduced visual acuity and high fever.
CT or MRI, IV abx and possibly surgical drainage.
117
Most common eye tumor?
Hemangioma.
118
Most common primary orbital malignancy in childhood? Average age onset?
Rhabdomyosarcoma
6-7 years.
119
Know the anatomy of the TM
Short process, pars flacida (11 o’clock), long process, umbo (center), pars tensa (3 o-clock) and cone of light
120
Cone of light to the _____ in the R ear and to the _____ in the L ear. Pointing to the ______
R
L
Nose
121
Age of ____ can do formal audiology testing.
5
122
What virus can increase risk for deafness?
CMV
123
Bottle feeding increases ET reflux.
124
Tobacco use in the home is an increased risk for Otitis Media.
125
TM can be red if _____ or _____
Crying or fever
126
Risk factors for OE
Excessive cleaning, hearing aid irritation, earplug use, summer months
127
Treated OE with abx and not getting better…?
Maybe fungal!
128
OE -usually no fever or URI symptoms.
129
Do not MISS! Mastoiditis. S/S? Work up?
Pain/inflammation over mastoid prominence, tenderness, swelling, erythema, fever, pinna displaced down and out. Pt looks sick. CT scan for eval and IV abx ASAP ENT/ER.
130
Mastoiditis is often a complication of ____
Otitis media (recurrent or untreated)
131
Tympanostomy Tube (TT). Do NOT do in kids:
OME <3mo
Those who have not had hearing testing
Recurrent acute OM withOUT effusion
132
TT offered for kids who:
OM >3months who have had hearing test.
Chronic OM with vestibular problems, poor school performance, behavioral problems and ear discomfort.
recurrent AOM WITH unilateral or bilateral effusion.
133
Watch videos on slide 34 ear PPT
134
Difference between AOM and OME.
AOM - acute infx treat with abx.
OME - irritation and effusion in middle ear.
135
Most common bacterial causative of AOM?
Strep pneumoniae, H. Influenza, m. Catarrhalis.
136
Very unusual to get AOM less than ______. Be concerned!
6 weeks of age.
137
Fever, irritability and poor feeding can indicate ______ in infants
AOM.
138
Make the dx of AOM IF (these 2 criteria sets are met)
1. Moderate OR severe bulging of the TM present OR new onset otorrhea (not from otitis externa)
2. Mild bulging of TM AND recent (<48h) onset of ear pain (rubbing, etc) OR intense erythematous of the TM.
139
Treat Children 6-23 months who: have AOM with otorrhea: _________.
AOM with severe symptoms (moderate or severe pain, persistent otalgia for >48hrs, temp >=102.2 in past 48hrs): ______
Bilateral AOM withOUT severe symptoms or otorrhea: _______
Unilateral AOM withOUT severe symptoms or otorrhea:______
Children >=24 months in same 4 situations?
6-23mo: Abx, Abx, Abx, Abx or OBS (close f/u in 48-72 hours)
>=24 mo: Abx, Abx, Abx or OBS, Abx or OBS.
140
Vaccines - if kids have missed (especially HIB or Prevnar) then that can make them have more ear infections.
141
1st line meds for AOM
High dose amoxicillin 80-90mg/kg/day PO in 2 divided doses.
142
What are contraindications for prescribing amoxicillin for AOM?
If kid has taken Amox in the past 30 days
no concurrent purulent conjunctivitis
not allergic to penicillin.
143
Allergic to PCN or received Amox in the past 30 days?
Augmentin 90/6.4mg/kg/day in 2 divided doses.
144
What is “recurrent AOM” and what can you do about it?
3 episodes in 6 months or 4 episodes in 1 year.
TT, pneumococcal and HIB vaccine and annual flu vaccine, exclusive breastfeeding for 6mo and avoid secondhand smoke exposure
145
If 4 of the 5 LLMBC are abnormal then it’s likely _____
AOM.
146
Avoid _____ in perforated TM.
Abx ear drops and other ear drops
147
Cholesteatoma
Destructive, expanding keratinizing squamous epithelium in the middle ear and/or mastoid process. Usually dx by age 4. Could cause erosion of ossicles, facial nerve palsy or SN or conductive hearing loss.
REFER to ENT
148
OME- fluid but no ____ or _____
Inflammation or infection.
149
How long does it take for eustatian tube dysfunction to resolve and fluid to be reabsorbed?
Up to 3 months. (79-90%)
150
No evidence to support allergy treatment for OME.
151
OME with allergy symptoms and nasal congestion?
Nasal steroids
152
Congenital hearing loss - reasons?
Prenatal infections, teratogenic drugs, perinatal injury, syndromes (>400 genetic syndromes associated with hearing loss)
153
>70% of deafness and hearing loss is NON-syndromic.
154
Milestone flash cards! With domains .
155
Better term for not meeting mental milestones…..
Intellectual disability
156
What is the VACTERL acronym associated with genetic conditions?
Vertebral anomalies
Anal atresia
Cardiac defects
Tracheoesophageal fistula
Renal anomalies
Limb anomalies
157
What disorders are known to have a later onset in life (dx at adolescent or early adult)? Examples?
Neuro degenerative disorders
Huntingtons, Spinocerebellar ataxia, spinal muscular dystrophy
158
Trisomy 18 - tell me about it!
<12% survive to 1 year.
Small, short stature, small nipples, chinodactyl, rocker bottom feet, hypo plastic nails, Inguinal, abdominal hernias, born pre-term.
159
Trisomy 13 - tell me about it!
20% live >1yr
Cleft lip/palate, microcephalic, deafness, missing ribs, polydactyl, renal anomalies.
160
Klinefelter - tel me about it!
47,XXY
1:580 males.
Tall thin, normal until puberty when secondary sex characteristics don’t develop. Infertile. Hypogonadism, increased risk for breast cancer
161
Turner syndrome - tell me about it!
1 in 32,000 F
Typical intelligence and life expectancy
Coarct of aorta
Low-set deformed ears, webbed neck, triangular face, infertility
162
Cri du chat - tell me about it!
5p
Tracheal hypoplasia, FTT, hypotonia, microcephaly.
163
Williams syndrome - tell me about it!
Moderate intellectual disability, verbal skills above deficiencies in other areas. Aortic stenosis.
164
You have a full-term baby with sepsis-like presentation but no risk factors … - what can you consider?
Metabolic condition
165
Marfan - tell me about it!
Myopia, ectopia lentils, aortic dilitation, bone overgrowth, joint laxity, scoliosis, pes planis (flat feet)
166
Ehller’s danlos syndrome (EDS) tell me about it!
Smooth skin, wide scars, poor healing, joint hyper mobility
167
What 6 things can potentially be affected by metabolic disorders?
1. Deficiency of an enzyme
2. Or its cofactors
3. Or its biochemical transporters
4. Deficiency of metabolite
5. Build up of toxic compound
6. Combo of above.
168
What labs relating to metabolic conditions should patients be checked for who present with AMS, irritability, neuro impairment or apparent sepsis?
Ammonia, blood glucose and anion gap.
169
What is categorized as “excessive” wt loss after birth?
>10% of birth weight
170
Peds normal glucose
>=45
171
APGAR components (0-2)
HR (0, <100,>100)
Resp (0 or ireg, slow, good)
Muscle tone ( limp, some flexion, active motion)
Reflex irritability/suctioning (none, grimace, cough/sneeze)
Color (blue/pale, acrocyanosis, all pink)
172
What attributes are measured in the Ballard score (o-4)?
Posture
Square window
Arm recoil
Popliteal angle
Scarf sign
Heel to ear.
Generally, the older the baby, the less flexible they are, except for the square window.
173
Difference between an omphalocele and gastroscisis
Omphalocele = central abd, +hernia sac, -umblilical ring, less frequent intestinal infarct/atresia
Gastroscisis = R para umbilical, -hernia sac, +umbilical ring, more frequent intestinal infarct/atresia.
174
Opioid withdrawal symptoms WITHDRAWALS
Wakefulness
Irritability/insomnia
Tremors, temp variation, tachypnea, twitching
Hyperactivity, high-pitched cry, hiccups, hypertonia/hyperreflexia
Diarrhea (explosive), diaphoresis, disorganized suck
Rub marks, resp distress, rhinorrhea, regurg
Apnea, autonomic dysfxn
Wt loss
Alkalosis (resp)
Lacrimation (photophobia), lethargy
Seizure, sneezing, stuffy nose, sweating, non-productive sucking
175
What is considered a low birth weight ?
<2,500g
176
Heart failure s/s at these time lines indicate what possible problem?
2 days, 2 weeks and 2 months
2 days - transposition of great arteries as PDA closes
2 weeks - Coarct of Aorta
2 months - VSD
177
Causes of IUGR
Poor maternal nutrition
Maternal HTN
Fetal anomalies
Infection
TTTS
178
What is hydrops fetalis? What are s/s?
Anemia secondary to immune hemolysis or decreased RBC production.
Excessive fluid accumulation in skin and other body cavity.
179
Non-immune hydrops causes?
Infx, malignancy, autoinflammatory disease or complex congenital anomalies.
180
What is the greatest risk for poor delivery or pregnancy outcome?
Maternal chorioamnionitis
181
What are the most common organisms causing early neonatal sepsis? Tx?
E.Coli and GBS.
Ampicillin and an Aminoglycoside (usually gentamycin)
182
Cafe au lait spots can be characteristic of which genetic condition?
Neurofibromatosis 1 (NFT1)
183
When should a baby double their birth weight? Triple? double height?
By 4-5 months
1 year
5 years
184
Caloric inadequacy is suspected if decreasing _____, ____ and ____ measurements (in that specific order)
Weight, length then head circumference
185
Causes of low growth rate
Organic - increased metabolic demand due to HF?
Non-organic - neglected child, maternal depression
Endocrine disorders (especially pituitary dysfunction)
186
When should depression screening start?
Age 11 with PHQ
187
When should peds patients get a one time lipid screening?
Age 9-11
188
When does bili measurement peak in infants? Should not exceed____
Day 3
12
189
Hyperbilirubinemia may be pathologic IF:
Present on 1st day of life or >13 at peak (day 3) in term babies.
190
What is the end result of untreated hyperbilirubinemai?
Kernicterus - chronic and permanent manifestations of biliruben-induced neurologic dysfunction (BIND)/ acute bilirubin encephalopathy
191
Some causes of pathologic hyperbilirubinemia?
G6PD
Hemolytic disease
Hypothyroid (>10 days of life)
192
Risk factors for hyperbilirubinemia
38 weeks or less gestation
Bruising
Visible jaundice
Maternal-fetal blood incompatibility
Exclusively breastfeeding
Sibling with hyperbili
Macrosomia baby of GDM mother
Down syndrome
Albumin <3
Severe disease in 1st 24hrs (Sepsis)
193
If TC is ____ then check serum
>=15
194
Direct bilirubin (conjugated) should not be more than ____ or ______ of total.
2 or greater than 20% of total
195
Erythromycin ointment for newborns is prophylactic for most except chlamydia. Chlamydia ophthalmia is treated with ________
PO abx to prevent chlamydia pneumonia.
196
Contact lens wearer conjuctivits or keratitis due to ____ infection.
Psudomonas
197
Tx for gonococcal ophthalmia
IV Ceftriaxone.
198
Episcleritis and anterior uveitis can be treated with
Topical steroids.
199
Other than leukokoria what other S/s are associated with retinoblastoma? What other diagnostic tool may be needed if bilateral leukokoria?
Abnormal pupil, strabismus, hyphema.
MRI to eval pineal gland if bilateral.
200
When diagnosing AOM - you will have poor TM mobility to positive and negative pressure via pneumatic otoscopy.
201
What is the most frequent causative agent of otitis externa?
Pseudomonas.
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Immunocompromised persons with DM get malignant otitis externa. IV abx. Mortality rate in adults is 15-20%. Relapse in first year is common.
203
If mom is antibody + and infant is DAT + only to anti-Rh and mom received Rhogam during pregnancy and known not to be anti-Rh+ before rhogam, how often should you check baby’s bili?
No need to other than usual TC screening
If any of above is NOT true, then measure TcB and TSB immediately and every 4 hours x2 and every 12 hrs x3
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What is considered a rapid rate of rise for TSB?
>= 0.3mg/dl/hr in 1st 24 hours or >= 0.2mg/dL/hr thereafter
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Should you be concerned if a breastfed baby looks jaundiced at 3-4weeks? Or formula fed baby at 2 weeks?
Yes. Check TSB.
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How soon after initiating phototherapy in the hospital should you recheck TSB?
12 hours.
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Can you use TcB to check bili in infants that are under phototherapy?
No. It will underestimate.
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When should hyperbili baby have escalated care and what does escalated care involve?
If TSB reaches 2mg/dL below exchange transfusion level.
Moved to NICU/PICU, blood draw and type and Cross. IV hydration, neonatology consult and measure TSB every 2 hours.
