MTB 2 CK - Pediatrics Flashcards
(135 cards)
1
Q
once the baby is delivered what do you do next
A
mouth and nose is suctioned then cutting/clamping of the umbilical cord, then dried/wrapped in clean towels and placed under a warmer.
2
Q
what is the normal heart rate in a baby
A
120-160 beats per minute
3
Q
what is the respiratory rate in a newborn
A
40-60 breaths per minute
4
Q
conjunctivitis most likely at day 1
A
chemical irritation
5
Q
conjunctivitis at 2-7
A
gonorrhea
6
Q
conjunctivitis after more than 7 days
A
chlamydia trachomatis
7
Q
conjunctivitis after 3 weeks or more in newborn
A
herpes infection
8
Q
newborns should receive what 2 types of antibiotics
A
erythromycin ointment or tetracycline ointment
silver nitrate solution
9
Q
neisseria gonorrhea conjunctivitis tx
A
ceftriaxone
10
Q
chlamydia conjunctivitis tx
A
oral erythromycin
11
Q
herpes conjunctivitis tx
A
systemic acyclovir and topical vidarabine
12
Q
give rhogram at what weeks
A
28-32 weeks and during delivery
13
Q
what week do you check for gbs
A
35-37 weeks
14
Q
amlodipine a/e
A
edema
15
Q
what should be given to newborn prophylactically
A
single IM dose of vitamin K
hep b vaccine
but newborns with HbSAg positive mother should get hep b vaccine and HBIG
16
Q
what is transient tachypnea of the newborn
A
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
Q
when should you do a csf analysis with lumbar puncture on newborn
A
neuro signs like irritability, lethargy, temp irregularity, and feeding problems
18
Q
transient hyperbilirubinemia in newborn
A
infant spleen removign excesss rbc with hbF- excess breakdown of rbc- leads to physilogical release of Hb and a rise in bilirubin
19
Q
subconjunctival hemorrhage in newborn
A
due to increased intrathoracic pressure of chest as being compressed while passing thru birth canal
tx- none
20
Q
newborn skull fractures from least dangerous to worst
A
linear-most common
basilar- most fatal
depressed- can cause cortical injuries but no surgical intervention
21
Q
caput succedaneum and cephalohematoma
A
do not cross suture lines
22
Q
duchenne-erb paralysis presentation in newborb
A
cant abduct shoulder, cant externally rotate, and cant supinate
23
Q
dx of ducehenne-erb palsy
A
clinical dx and tx with immoblization
24
Q
klumpke paralysis of newborn
A
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
