MTB 2 CK - Pediatrics Flashcards Preview

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Flashcards in MTB 2 CK - Pediatrics Deck (135):
1

once the baby is delivered what do you do next

mouth and nose is suctioned then cutting/clamping of the umbilical cord, then dried/wrapped in clean towels and placed under a warmer.

2

what is the normal heart rate in a baby

120-160 beats per minute

3

what is the respiratory rate in a newborn

40-60 breaths per minute

4

conjunctivitis most likely at day 1

chemical irritation

5

conjunctivitis at 2-7

gonorrhea

6

conjunctivitis after more than 7 days

chlamydia trachomatis

7

conjunctivitis after 3 weeks or more in newborn

herpes infection

8

newborns should receive what 2 types of antibiotics

erythromycin ointment or tetracycline ointment
silver nitrate solution

9

neisseria gonorrhea conjunctivitis tx

ceftriaxone

10

chlamydia conjunctivitis tx

oral erythromycin

11

herpes conjunctivitis tx

systemic acyclovir and topical vidarabine

12

give rhogram at what weeks

28-32 weeks and during delivery

13

what week do you check for gbs

35-37 weeks

14

amlodipine a/e

edema

15

what should be given to newborn prophylactically

single IM dose of vitamin K
hep b vaccine
but newborns with HbSAg positive mother should get hep b vaccine and HBIG

16

what is transient tachypnea of the newborn

when newborn passes thru vaginal canal, compression of rib cage helps in removal of fluid from lungs
newborns delivered with c-section- have excess fluid in lungs and are hypoxic
if hypoxic for more than four hours, get urine and blood culture

17

when should you do a csf analysis with lumbar puncture on newborn

neuro signs like irritability, lethargy, temp irregularity, and feeding problems

18

transient hyperbilirubinemia in newborn

infant spleen removign excesss rbc with hbF- excess breakdown of rbc- leads to physilogical release of Hb and a rise in bilirubin

19

subconjunctival hemorrhage in newborn

due to increased intrathoracic pressure of chest as being compressed while passing thru birth canal

tx- none

20

newborn skull fractures from least dangerous to worst

linear-most common
basilar- most fatal
depressed- can cause cortical injuries but no surgical intervention

21

caput succedaneum and cephalohematoma

do not cross suture lines

22

duchenne-erb paralysis presentation in newborb

cant abduct shoulder, cant externally rotate, and cant supinate

23

dx of ducehenne-erb palsy

clinical dx and tx with immoblization

24

klumpke paralysis of newborn

claw hand with horner syndrome

25

facial nerve plasy in newborn causes

forcep use in delivery

26

tx of facial nerve palsy in newborn

improvement occurs gradually over weeks to months
if no improvement then surgical repair of nerve

27

polyhydramnios def

too much fluid because the fetus is not swallowing

28

causes of polyhydramnios

werdnig hoffman syndrome
intestinal atresia

29

oligohydramnios

too little fluid because the fetus cant urinate

30

causes of oligohydramnios

prune belly- lack of abdominal muscles so cant bear down and urinate
-tx of prune belly is serial foley catheter placements but carries high risk of uti
renal agenesis- assoc with potter syndrome and incompatible with life
flat facies

31

where is the defect in morgagni

retrosternal or parasternal

32

where is the defect in bochdalek

posterolateral

33

omphalocele cause

failure of gi sac to retract at 10-12 weeks

34

gastroschisis occurs where

lateral to midline with no sac covering

35

umbilical hernia is highly associated with what

congenital hypothyroidism

36

tx of umbilical hernia

90 percent close spontaneously by age 3 but if doesn't after age 4, then surgical intervention to prevent bowel strangulation and subsequent necrosis

37

wilms tumor caused by

hemihypertrophy of one kidney due to increased vascular demands

38

presentation of wilms tumor

constipation, n/v, abdominal pain, palpable abdominal mass, aniridia

39

dx of wilms tumor

abdominal ultrasound is the best initial
most accurate is the contrast enhanced ct scan

40

tx of wilms

nephrectomy with chemo and radiation

41

neuroblastoma dx

hypsarrhythmia on eeg and opsomyoclonus

42

hydrocele

painless swollen fluid filled sac, transilluminates
remanant of tunica vaginalis
resolve w/n 6 m.
dx with ultrasound

43

varicocele best initial test

Physcial exam coinciding with a bag of worms sensation
ultrasound of scrotal sac showing dilatation of pampiniform plexus

44

cryptorchidism tx

orchipexy to bring testicle down into scrotum after age 1 to avoid sterility

45

cryptorchidism increase risk of malginancy regardless of surgical intervention true or false

true

46

what is contraindicated in hypospadias

circumcision bc diffficulty in surgical correction then

47

hypospadias highly associated with what

cryptorchidism and inguinal hernia

48

epispadias highly associated with what

urinary incontinence; evaluate for concomitant bladder exstrophy

49

why does squatting help in TOF

increase in preload increases systemic circulation resistance, decreases R to left shunt, leading to increased pulmonary blood flow and increase blood oxygen sat

50

tx of transposition of great vessels

prostaglandin E1 to keep patent ductus arteriosisu open
nsaids/indomethacin contraindicated
two surgeries are necessary

51

pulsus alterans seen in what

left ventricular systolic dysfunction

52

pulsus bigeminus seen in what

hocm

53

pulsus bisferiens seen in what

AR

54

pulsus tardus seen in what

AS

55

hypoplastic left heart syndrome

left ventricular hypoplasia, mitral valve atresia, and aortic valve lesions
gray cyanosis rather than blue
precordial hyperactivity, loud second heart sound, weak pusles

56

truncus arteriosus

severe dyspnea, early and frequent resp infections within first few days

57

tx of truncus arteriosus

surgery to prevent pulmonary htn which develops within 4 months

58

TAPVR with obstruction

early in life with resp distress and severe cyanosis

59

dx of TAPVR with obstruction

chest xray shwoing pulm edema
echo is definitive

60

TAPVR without obstruction

1-2 years of age with right heart failure and tachypnea

61

tapvr without obstruction dx

CXR showing snowman or figure 8 sing
most accurate is echo- have to diagnose with this

62

VSD conservative tx

diuretics and digoxin otherwise larger or more symptomatic lesions require surgery

63

vsd and asd dx

cardiac cath is the most definitive test
but echo is less invasive and just as effective

64

prolong qt syndrome

hearing loss, syncope, normal vitals and exam, fm hx of sudden cardiac disease

65

3 sign on chest xray signifies what

coarctation of aorta

66

tx of coarctation of aorta

surgical resection of narrowed segment and then balloon dilation if recurrent stenosis occurrs

67

hyperbilirubinemia is pathological when?

appears on first day of life
bilirubin increases more than 5 a day
direct bilirubin is above 2
bilirubin arises above 19.5 in a term child
persists after second week of life

68

tx of hyperbilirubinemia

blue green light helps break down bilirubin to excretable components
consider exchange transufson if bilirubin arises above 20-25

69

tx of Trachoesophageal fistula

surgical repair in two wteps
antibiotic coverage for anaerobes
fluid resus before surgery to prevent dehydration

70

string sign and olive seen seen where

pyloric stenosis

71

doughnut sign seen where

intusseption

72

best intial test for pyloric stenosis

abdominal ultrasound showing thickened pyloric sphincter

73

when is pyloric stenosis seen

first month of life but can be seen upto six months after birth

74

shoulder sign is what in pyloric stenosis

filling defect in the antrum due to prolapse of muscle inward

75

what is mushroom sign in pyloric stenosis

hypertrophies pylorus against the duodenum

76

railroad track sign in pyloric stenosis

excess mucosa in the pyloric lumen resulting in two columns of barium

77

best intial test for chaonal atresia

pass NG tube
most accurate: ct scan

78

first step in management of choanal atresia

secure airway

79

tx of choanal atresia

surgery to perforate the membrane and reconnect the pharynx to the nostrils

80

dx of duodenal atresia

abdominal xray and double bubble
first day of life

81

first step in management dudoenal atresia

iv fluids

82

tx of pyloric stenosis

replace lost volume with iv fluids, replace lost electrolytes especially potassium
NGT to decompress the bowel
surgical myotomy

83

CHARGE syndrome

coloboma of eye
heart defects
atresia of choanae
retardation of growth
genital defects
ear anomalies

84

hirschsprung disease

do not pass meconium for over 48 hours or fail to pass meconium at all
extreme constipation followed by large bowel obstruction
rectal eaxm shows extremely tight sphincter; cant pass flatus

85

dx of hirschsprung disease

plain xray shows distended bowel loops with lack of air in rectum
contrast enema shows retention of barium for greater than 24 hours
manometry will show high pressures in the anal sphincter
mainstay of dx is full thickness biopsy revealing lack of ganglionic cells in submucosa

86

VACTERL syndrome

veretebral anomalies
anal atresia
cardivascular anomalies
tef
esopghaeal atresia
renal anomalies
limb anomalies

87

dx of imperforate anus

not being able to pass meconium and physical exam will reveal no anus

88

dudoenal atresia is associated with what

down syndrome and annular pancreas

89

duodenal atresia presentation

bilious vomiting within 12 hours of birth
xray shows classic double bubble sign

90

tx of duodenal atresia

replace lost volume with IV fluids
replace potassium
NGT to decompress the bowel
surgical duodenostomy-most common/definitive tx

91

birds peak appearance seen in what two situations

volvulus and achalasia

92

volvulus presentation

vomiting and colicky abdominal pain
multiple air fluid levels seen
first year of life

93

best initial therapy for volvulus is

iv fluids
endoscopic decompression

94

most effective tx if endoscopy fails in volvulus

surgical decompression

95

intussusception associated with

previous rotavirus vaccine and HSP

96

intussusception caused by what

polyp, hard stool, lymphoma, or even have a viral origin

97

intussusception presentation

bilious vomiting, currant jelly stool, and colicky abdominal pain
right quadrant sausage shaped mass can be palpated
first year of life

98

dx of intussusception

ultrasound will show doughnut sign or target sign

99

most accurate test for intussusception

barium enema both diagnostic and therapeutic

100

tx of intussusception

fluid resus and balancing electrolytes
NGT decompression of bowel
barium enema- must observe bc 10 percent recur w/n 24 hours
if barium enema not curative then emergent surgical intervention

101

norwalk virus

explosive cramping pain, epidemic, short lived 1-2 days

102

necrotizing enterocolitis

seen in premature infants with low birth weight, vomiting/abdominal distention, fever

103

dx of necrotizing enterocolitis

abdominal xray shows pneumatosis intestinalis- air within bowel wall and ct with air in the portal vein, dilated bowel loops
frank or occult blood can be seen in stool

104

tx of necrotizing enterocolitis

feeding discontinued
iv fluids immediately
ngt for bowel decompression
if these does not help then surgery to remove affected bowel

105

small left colon syndrome seen where

in infants of diabetic mothers
congenitally smaller descending colon leads to distention from constipation
tx with repeated smaller and more frequent feeds

106

major cardiac change seen in infants of diabetic mothers

asymmetric septal hypertrophy- bc obliteration of left ventricular lumem causing decreased cardiac output
dx with ekg and echo
tx with bb and iv fluids

107

CAH dx

increased 17-OH progesterone level at birth

108

17 alpha hydroxylase def

increase in aldosterone decrease in sex steroids and cortisol
female: normal at birth
male: pseudohermaphrodite

109

21 hydroxylase def

decrease in aldosterone and cortisol
increase in sex hormones
female: virilized
male: normal at birth

110

11 b hydroxylase def

decrease in aldosterone and cortisol
increase in sex hormones
girls: virilized
boys: normal at birth
11-doc increased

111

children at what age are most susceptible to rickets

6-24 months

112

infants who are exclusively breast fed should be given what

vitamin d supplements at 2 months of age

113

tx of neonatal sepsis

gentamicin and ampicillin
cefotaxime

114

neonatal taxoplasmosis

chorioretinitis, hydrocephalus, mutiple ring enchancing lesions on ct

115

neonatal taxoplasmosis dx

elevated igM to taxoplasma- best initial
most accurate: pcr

116

tx for taxoplasmosis

pyrimethamine and sulfadiazine

117

rubella

pda, cataracts, deafness, hps, thrombocytopenia, blueberry muffin rash, and hyperbilirubinemia

118

dx of rubella

maternal igM along with clincal diagnosis

119

tx of neonatal rubella

supportive

120

neonatal cmv

periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae

121

dx of cmv

best initial: urine or saliva viral titers
most accurate: urine or saliva PCR for viral DNA

122

tx of scarlet fever

penicillin, azithromycin, or cephalosporin

123

croup

barking cough, coryza, inspiratory stridor, difficulty breathing when lying down, signs of hypoxia like acessory muscle use or peripheral cyanosis

chest xray: steeple sign

124

dx of croup

made clinically, rarely need xray

125

tx of croup

mild symptoms: steroids
moderate/severe: epinephrine

126

tx of epiglottis

intubate the child in the OR
administer ceftriaxone for 7-10 days
rifampin given to all close contacts

127

what do the three stages of whooping cough present with

catarrhal stage: congestion and rhinorrhea-14 days
paroxysmal stage: severe coughing with extreme gasp for air followed by vomiting-14-30 days in duration
convalescent stage: decrease of frequency of coughing-14 days

128

tx of whooping cough

erythromycin or azithryomycin only in catarrhal stage
isolate child and macrolides for all close contacts

129

tx of diphtheria

antitoxin

130

pharyngitis

cervical adenopathy, petechiae, fever above 104, other URI symptoms, acute rheumatic fever and GN

131

dx of pharyngitis

rapid DNAse Ag detection test

132

tx of pharyngitis

oral pcn for ten days or macrolides if pcn allergry

133

what is Legg Calve Perthes disease

avascular necrosis of femoral head showing painful limp

134

dx of legg calve perthes

xray showing joint effusion and widening

135

tx of legg calve perthes

nsaid and rest
follow with surgery on both hips