Final

Question 1

cleft lip and palate

Answer 1

• Failure of development in first trimester of gestation
• Prevented by folic acid
• Can be lip or palate or both
• Usually occurs in isolation w/o any other problems
• Etiology: can be caused by smking, alcohol, anticonvulsants, phenytoin, steroids

Question 2

cleft lip and palate treatment

Answer 2

• Special feeders, keep upright after and during feedings, burp more frequently
• Repair lip in 6 months and palate in 18 months
• Post op – airway management, maintain suture line, nutrition
• Long term needs – dental care, orthodontia, speech/hearing, plastic surgery, self image

Question 3

Tracheo-Esophageal Fistula / TEF

Answer 3

• Esophagus ends and trachea is attached to stomach
• Malformation that happens in week 4 or 5 of gestation
• Triad S/S – drooling/choking, cyanosis and cough
• High aspiration risk. Surgical emergency – close fistula of trachea and esophagus, insert G tube and reattach esophagus

Question 4

TEF Preop

Answer 4

Suction any secretions, maintenance IV fluids, monitor VS

Question 5

TEF Postop

Answer 5

Measure gastrostomy drainage, IV fluids and antibiotics. TPN may be needed. Feedings introduced slowly and in small amounts. Assess for respiratory difficulty

Question 6

intussusception

Answer 6

part of intestine prolapses into another (small intestine into large). abrupt onset, pain, vomiting and currant jelly stools (bright red, mix of mucus and blood). can cause bowel ischemia, perforation and periodontitis
tx: enemas or surgery. then watch for return of normal brown stools

Question 7

volvulus

Answer 7

abnormal rotation of intestine into abdominal cavity during development

Question 8

pyloric stenosis

Answer 8

• Overgrowth of pyloric muscle
• Obstruction in passage of stomach and duodenum
• Causes projective vomiting, dehydration, irritability and hunger, hard mass abdomen w/ visible peristalsis, scrawny baby

Question 9

Hirschsprung Disease

Answer 9

• Congenital
• Lack proper innervation of colon
• Lack peristalsis, may have constipation
• Tx: remove effected part of the bowel

Question 10

imperforate anus

Answer 10

anus is not fully developed. repair surgically. risk for fibrosis or scarring of tissue during surgery (so they have less control or feeling there). may need anal dilation

Question 11

hernias

Answer 11

protrusion of an organ through the muscle wall of the cavity that normally contains it. Inguinal and umbilical hernias are common in children

Question 12

appendicitis

Answer 12

• Most common cause of emergency abdominal surgery in children
• Inflammation of appendix
• S/S – vomiting, fever, localized pain
• If they suddenly feel better it likely means they ruptured
• Tx – surgical removal

Question 13

short bowel/gut syndrome

Answer 13

decreased capacity to absorb/digest food due to loss of intestine (can be from many different causes/conditions). may need TPN, may recover. goal is to get to enteral and oral feedings

Question 14

colic

Answer 14

• Paroxysmal abdominal pain in young infants
• Onset is 2 to 6 weeks and resolves by 3 months
• Baby cries a lot
• Tx - Need to support families, rocking baby rhythmically, white noise, swaddling, pacifier

Question 15

Gastroesphageal reflux

Answer 15

• Most common cause of organic failure to thrive
• Backflow of gastric contents into esophagus bc sphincter is inappropriately relaxed
• Common < 3 months of age
• Tx – depends on severity. Positioning (on left side), meds (Zantac, PPI), smaller feedings with food that digests quicker

Question 16

G tube indications

Answer 16

Indications: difficulty swallowing, inadequate nutrition, difficulty gaining weight

Question 17

gastroenteritis

Answer 17

inflammation of stomach and intestines. 2nd leading cause of death worldwide in children under 5. very common, dehydration, vomiting, diarrhea. wash hands to prevent spread.

Question 18

constipation

Answer 18

• Difficulty passing stool or hard stool
• ¼ of all GI referrals
• Managed with diet, fluids, meds (stool softener or enema) and toileting routine
• Encopresis – hold BM so long that it builds up in gut

Question 19

clubfoot / talipes equinovarus

Answer 19

• Genetic component and more common in males, may be secondary to abnormal uterine positioning, may be neuromuscular or vascular problems
• Foot folded up against leg, muscles in lower limbs atrophied, smaller foot
• Tx: surgery is last resort. Serial casting – regular and aggressive stretching of soft tissue until foot is in more of a natural position

Question 20

Developmental dysplasia of the hip

Answer 20

4 types
• S/S – no pain in infancy, not always apparent at birth. Less mobility/flexibility on one side. Painless limp in toddler, waddling duck-like gait in older child. Overtime untreated will cause limp and pain
• Treatment – observation, pavlik harness (to keep kid flexed and abducted), Seattle seat, surgery, Spica cast

Question 21

Hip dislocation

Answer 21

type of developmental dysplasia of the hip. femoral head is dislocated from acetabulum

Question 22

Dislocatable hip

Answer 22

type of developmental dysplasia of the hip. femoral head is in acetabulum but may be dislocated fully when stressed

Question 23

Subluxable hip

Answer 23

type of developmental dysplasia of the hip. femoral head moves partly out of acetabulum

Question 24

Acetabular dysplasia

Answer 24

type of developmental dysplasia of the hip. Acetabulum is shallow and lost its cup shape

Question 25

Legg-Calve-Perthes

Answer 25

hip joint loses circulation, atrophies and becomes necrotic. Self limiting. Lasts several months to a year. Dead bone is resorbed and replaced in 1-3 yrs. S/S - pain worse with activity, limp, "stiff hip"

Question 26

Scoliosis

Answer 26

Lateral curvature of spine more than 10 degrees

Question 27

Scoliosis treatment

Answer 27

observation (up to 30 degrees), bracing, surgery if > 40 degrees, cosmesis, sitting balance, pressure sore prevention. If 100 degrees then surgery to prevent cardiopulmonary compromise

Question 28

Muscular Dystrophy

Answer 28

* Muscle fibers replaced by disease, fatty, cartilage tissues. Progressive to entire musculature and terminal. * S/S – muscle weakness, unusual gait, progressives to otheries systems (scoliosis, respiratory difficulty, cardiomyopathy), die in 20s

Question 29

Muscular Dystrophy treatment

Answer 29

supportive care, prednisone and deflazacort, surgery for deformities, respiratory therapy, mental health support

Question 30

Slipped capital femoral epiphysis

Answer 30

femoral head falls off. caused by growth spurt, trauma, sports injury, overweight, endocrine disorder

Question 31

Osteogenesis imperfecta

Answer 31

o Brittle bone disease o Genetic biochemical defect in production of collagen o Concern about mobility and safety

Question 32

sports injury prevention

Answer 32

o Protective gear o Gradual increase of duration and intensity of exercise o Warm up and cool down o Need coaches who are prepared in sport, developmentally appropriate expectations and emergency care

Question 33

Juvenile idiopathic arthritis

Answer 33

``` 3 major types: oligoarthritis, polyarthritis, systemic arthritis o S/S  Joint swelling, pain  Stiffness when walking  Limp, uneven growth  Loss of joint motion ```

Question 34

Juvenile idiopathic arthritis treatment

Answer 34

 Pain management (NSAIDs, steroids)  Surgery – for pain relief or improved function when contractures  Alternative methods – massage, heat, cold

Question 35

oligoarthritis

Answer 35

less than 5 joints, usually in bigger joints (knees, ankles, elbows). Watch for uveitis

Question 36

polyarthritis

Answer 36

5 or more joints. Can be any joints. Uveitis less often

Question 37

systemic arthritis

Answer 37

high fever, rash, polyarthritis, organ inflammation

Question 38

Conjunctivitis causes

Answer 38

o Bacteria – sudden onset, bilateral, red eyes, eyes stick together, contagious o Viral – unilateral, watery eyes, milder, light sensitive, contagious o trauma o irritants Tx: eye drops or ointment

Question 39

Hyperopia

Answer 39

farsighted, cannot see close up well. can see far away well

Question 40

Myopia

Answer 40

nearsighted, cannot see far away well.

Question 41

astigmatism

Answer 41

light is distorted as it goes through eye. corrected with refraction

Question 42

Strabismus

Answer 42

in newborns and should clear up by 3 years old muscle quits when tired and eye doesn't focus - see double vision. Tx - surgery, eye patches, eye exercises If untreated can lead to amblyopia

Question 43

Amblyopia

Answer 43

"lazy eye". caused by untreated strabismus neurologically the brain forgets about an eye. nerve pathways don't develop from eye to brain. This needs to be picked up and treated by age 5-6

Question 44

Retinal hemorrhage

Answer 44

caused by extreme trauma. Probably an intentional injury like abuse

Question 45

Otitis media causes

Answer 45

* Risk factors: boys, winter, children who use pacifiers a lot, smking households, allergies, clefts and Down syndrome * Causes: relation to Eustachian Tube Dysfunction, associated with URI, Strep Pneumo, H. flu, Moraxella catarrhalis, enlarged adenoids, allergic rhinitis

Question 46

Otitis media S/S

Answer 46

– pain, pulling on the ear, irritability, vomiting/diarrhea, fever, discharge, sleeplessness

Question 47

Otitis media treatment

Answer 47

o Wait and watch, pain control with Tylenol and ibuprofen. Comfort measures (fluids, don’t lie flat) o Watch for hearing and speech problems o If it becomes acute, use antibiotics, amoxicillin is first line

Question 48

Lymph nodes

Answer 48

* Small, nontender, movable are normal | * Large, tender, immovable, firm, hot should be referred

Question 49

Post Op Tonsillectomy

Answer 49

o Signs of bleeding (freq swallowing could mean they are swallowing blood) o Pain management (oral narcotic) o Hydration o Hygiene o Teaching (white patchy throat, referred ear pain, and smelly breath in normal). Worry if there is a fever or bleeding or not drinking fluids

Question 50

Epistaxis

Answer 50

``` nosebleeding • Common from picking nose • Anterior treatable with first aid o keep kid calm o keep head in neutral position (leaning head back will drain blood into throat) o apply pressure to soft part of nose for about 10 min • Posterior more serious • Evaluate if recurring or severe ```

Question 51

Foreign body in nasal passage

Answer 51

* Unilateral stinky drainage | * Clear drainage could be CSF and it is serious – head injury

Question 52

Diaper dermatitis (rash)

Answer 52

* Primary reaction to urine, feces, moisture or friction * Candida albicans * Glazed red plaques – severe shows fiery red raised rash and possible pustules * Treatment depends on severity and nature

Question 53

Seborrheic dematitis

Answer 53

found over areas of body where sebaceous glands are more prolific. S/S - mild erythema, scaling yellow-red patches, greasy scaling, less itchy than atopic dermatitis. Tx - good hygiene

Question 54

Thrush

Answer 54

* Caused by oral candidiasis * Acute in newborns * Chronic in children with immune suppression, corticosteroid inhalers or antibiotic therapy * S/S – white patches that look like coagulated milk, difficulty feeding * Tx – nystatin suspension and other antifungals

Question 55

Acne

Answer 55

* Chronic inflammatory disorder of pilosebaceous hair follicles * Most common skin disorder in pediatric population * S/S – whiteheads, blackheads, papulopustular and cystic lesions

Question 56

Acne treatment

Answer 56

``` o good skin care with no astrigents or vigorous scrubbing o avoid picking or squeezing lesions o shampoo o balanced diet o meds (like Accutane) ```

Question 57

Impetigo

Answer 57

* Bacterial * Vesicle, pustule * Very contagious * Can lead to community based MRSA

Question 58

Impetigo treatment

Answer 58

o Remove crusts o Antibiotic oral or cream o Avoid cross-contamination o Stay out of school 48 hours after Rx begins, alert other parents

Question 59

Ringworm (tinea corporis)

Answer 59

* Fungus of skin, hair, nails * Contagious by touch * Topical or oral antifungal * Can also occur in foot, jock or scalp

Question 60

Partial thickness burn

Answer 60

1st and 2nd degree burns o Tissues can regenerate o Epidermis and dermis affected o Painful bc there are nerve endings here

Question 61

Full thickness burn

Answer 61

``` 3rd degree burns o Tissue cannot regenerate o Epidermis, dermis, underlying tissue o Not painful o Grafting required ```

Question 62

Full thickness burn

Answer 62

``` 3rd degree burns o Tissue cannot regenerate o Epidermis, dermis, underlying tissue o Not painful o Grafting required ```