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Flashcards in Paeds Deck (169):
1

normal RR newborn

40-60 BrPM

2

normal HR newborn

120-160 bpm

3

things that are done for every baby

- mouth and nose suctioning
- clamping and cutting umbilical cord
- dried, wrapped--> warmer
- gentle rubbing or stimulating the heels

4

one minute APGAR score

during labour and delivery conditions

5

five minute APGAR score

response to resuscitative efforts

6

appearance 0 point APGAR

blue all over

7

appearance 1 point APGAR

blue extremities

8

appearance 2 point APGAR

normal all over

9

pulse 0 point APGAR

Asystole or less than 60

10

pulse 1 point APGAR

60-100bpm

11

pulse 2 point APGAR

greater than 100bpm

12

grimace 0 point APGAR

no response

13

grimace 1 point APGAR

grimace/ feeble cry

14

grimace 2 point APGAR

sneeze/cough

15

activity 0 point APGAR

none

16

activity 1 point APGAR

some flexion

17

activity 2 point APGAR

active movement

18

resp 0 point APGAR

absent

19

resp 1 point APGAR

weak or irregular

20

resp 2 point APGAR

strong

21

all newborns receive eye care...

- erthromycin or tetracycline ointment
- silver nitrate solution

22

day 1 red eye

silver nitrate

23

days 2-7 red eye

gonorrhoea
PREVENTABLE with ointments
Tx: ceftriaxone

24

days +1 week red eye

chalmydia
NOT preventable with ointments
Tx: oral erythromycin

25

days +3weeks red eye

herpes
Tx: acyclovir systemic

26

decrease mortality of vit K bleeding

IM vit K dose

27

national screening tests newborn USA:

- PKU
- CAH
- CF
- hypothyroidism
- beta thalassemia
- homocyteinuria
- biotinidase
- hearring test

28

mum is hep B positive, what does baby get?

BOTH active and passive
- active: vaccine
- passive: HBIG

29

3 transient conditions in the newborn

- transient polycythemia
- TTN
- transient hyperbilirubinemia

30

splenomegaly normal in newborns

yessssss

31

TTN timing

first 4 hours

32

if tachypnea greater than 4 hrs

SEPSIS-- do blood and urine cultures, and LP if neuro/irritable

33

what % of newborns are jaundiced?

60%

34

delivery associated injuries

- subconjunctival hemorrhage
- skull fractures
- scalp injuries
- brachial
- clavicular fracture
- facial nerve palsy
- AF abnormalities

35

most common skull fracture during delivery

LINEAR fracture

36

most fata skull fracture during delivery

BASILAR fracture

37

caput succedaneum

CROSSES the midline

38

cephalohaematoma

DOES NOT cross the midline

39

prune belly

oligohydramnios: lack abdo muscles, unable to bear down and urinate

40

tx prune belly

serial foley catheter !!!! UTI risk

41

werdnig hoffman AF

POLY-- since cannot swallow

42

tx for facial palsy delivery injury

NOPE

43

air fluid levels in chest, and bowel sounds heard in back

congenital diaphragmatic hernia

44

morgagni

CDH-- retrosternal or parasternal

45

bochdalek

CDH- MORE COMMON, L side posterolateral

46

most common cause for elevated AFP

incorrect dating

47

mcc abdo mass in children

WILMS TUMOR

48

best initial test for wilms tumors

abdo US

49

most accurate test for wilms tumor

CT with contrast

50

tx wilms

TOTAL nephrectomy + Ctx, Rtx

51

most common cancer in infancy

neuroblastoma

52

most common extra cranial solid malignancy in infancy

neuroblastoma

53

PC neuroblastoma

- hypsarrhythmia EEG
- opsomyoclonus and cerebellar ataxia
- increase VMA and metanephrine on urine

54

varicocele imaging

ALWAYS US the OTHER testicle

55

when to tx varicocele

- delayed testes growth
- evidence of testicular atrophy

56

risk of malignancy and cryptorchidism with sx

MALIGNANCY RISK CONTINUES despite surgery

57

most common cyanotic heart lesion in children

TOF

58

most common cyanotic heart lesion in neonates

TGV

59

TOF a/w

chromosome 22 deletions

60

murmur in TOF

holosystolic in LLSB

61

squatting in TOF

increase preload
increase SVR

62

VSDs a/w

TRISOMIES
- downs
- edwards
- pataus

63

3 holosystolic murmurs

- MR
- TR
- VSD-- thus TOF

64

TGV imaging

egg on string

65

pulsus alterans

alternating strong and weak beats
-->LV systolic dysfunction

66

pulsus bigeminus

two heartbeats close together followed by a longer pause
--> HOCM

67

pulsus bisferiens

on palpation of the pulse, a double peak per cardiac cycle can be appreciated
--> AR

68

HY a/w hypoplastic L heart

GG
G-gray
G-globular heart

69

truncus arteriosus surgery

must be completed early to prevent PUL HTN

70

TAPVR

no venous return between pulmonary veins and L atrium

71

TAPVR with obstruction PC

EARLY LIFE
- resp distress
- severe cyanosis

72

TAPVR without obstruction PC

AGE 1-2 years old
- RHF
- tachypnea

73

TAPVR with obstruction CXR

pulmonary edema

74

TAPVR without obstruction CXR

snowman appearance or figure 8 sign

75

diagnosis of TAPVR with or without obstruction

ECHO

76

purpose of surgery in TAPVR with obstruction

DEFINITIVE tx

77

purpose of surgery in TAPVR without obstruction

RESTORE proper blood flow

78

VSD PC

- acyanotic
- FTT
- holosystolic murmur LLSB

79

2 cyanotic heart lesions a/w VSD

- TOF
- Truncus arteriosus

80

2 cyanotic heart lesions = PDA dependent

- TGV
- HLH

81

most common congenital heart lesion

VSD

82

HY a/w ASD

fixed wide splitting S2

83

PC ASD ....

later in life
- dyarrhythmias
- paradoxical emboli-- STROKE

84

PDA in first 12hrs

normal

85

PDA after 24hrs

PATHOLOGIC

86

best initial test for PDA

ECHO

87

most accurate test for PDA

cardiac catheterization

88

pear shaped heart

pericardial effusion

89

jug handle shaped heart

primary pulmonary artery HTN

90

PC
- hearing loss
- syncope
- fam Hx SCD
- normal vitals/exam

LONG QT SYNDROME

91

PC kernicterus

- hypotonia
- choreoathetosis
- hearing loss
- seizures

92

big risk with tef

aspiration pneumonia

93

vomiting with first feed=

TEF

94

4 signs of pyloric stenosis

1. string sign
2. shoulder sign
3. mushroom sign
4. railroad track sign

95

string sign

THIN COLUMN of barium leaking through the tightened muscle

96

shoulder sign

filling defect in the antrum due to prolapse of muscle inward

97

mushroom sign

hypertrophic pylorus against duodeum

98

railroad track sign

excess mucosa in pyloric lumen= 2 columns of barium

99

auscultation of pyloric stenosis

succussion splash

100

electrolyte disturbance in pyloric stenosis

hypochloraemic, hypokalaemic metabolic alkalosis

101

what worsens the potassium loss in pyloric stenosis?

ALDOSTERONE

102

choanal atresia by definition

membrane between the nostrils and the pharyngeal space, preventing breathing during feeding

103

feeding and choanal atresia

BLUE

104

crying and choanal atresia

PINK

105

initial step of choanal atresia

passing NG tube

106

most diagnostic test for choanal atresia

CT scan

107

first step in mgmt of choanal atresia

secure airway

108

CHARGE syndrome

C-coloboma and CNS abnormalities
H-heart defects
A-atresia choanae
R-retardation growth and development
G-GU defects (hypogonadism)
E-ear anomalies and or deafness

109

respiratory distress and esophageal atresia

ONLY during feeds

110

initial test for esophageal atresia

CXR

111

timing for hirschsprungs

failure to pass meconium within 48hrs

112

dx of hirschsprungs

- PFA- distension
- manometry- increase pressure of anal sphincter
- full thickness bx

113

dx of imperforate anus

CLINICAL

114

wrong answers for dx of imperforate anus

- manometry
- barium

115

duodenal atresia=

LACK or ABSENCE of apoptosis

116

timing of duodenal atresia

12 hours

117

volvulus imaging sign

BIRD BEAK

118

two things a/w intussusception

- rotavirus
- HSP

119

triad of symptoms for intussusception

- currant jelly stools
- abdo pain with sausage like mass in RUQ
- vomiting billious

120

best initial test for intussusception

US-- doughnut/ target sign

121

diagnostic and therapeutic test for intussusception

BARIUM ENEMA

122

most important first thing for intussusception

fluids and electros

123

second most common cause of infant death worldwide

GASTRO/DIARRHEA

124

mild case of diarrhea

oral fluids

125

severe case of diarrhea

IV fluids

126

loperamide in kids diarrhea

NO NO NO NO NO

127

rotavirus and adenovirus= blood?

NO NO NO NO NO NOT BLOODY

128

after confirmed evidence of NEC

Abx:
- vancomycin
- gentamicin
- metronidazole

129

big tx for NEC

IV FLUIDS, if failed
SURGERY

130

infant with diabetic mother-- GI

small L colon syndrome

131

dx small left colon syndrome

barium study-- congenitally smaller descending colon--> constipation

132

major cardiac change in infants of diabetic mothers

asymmetric septal hypertorphy

133

renal vein thrombosis

infants of diabetic mothers
- flank mass
- possible bruit
- hematuria
- thrombocytopenia

134

different types of rickets

- vit d deficient rickets
- vit d dependent rickets
- X-linked hypophosphataemic rickets

135

vit d dependent rickets

inability to convert 25,OH vit D to 1,25 OH vit D

136

dx of vit D defieicny CXR

rachitic rosary

137

infant exclusively breastfed it D supplements starting from

2 months of age

138

vit D dependent rickets labs

decrease calcium
decreased 1,25
normal phosphate
normal 25,OH

139

X-linked hypophosphataemic rickets

everything normal except
DECREASED PHOSPHATE

140

most common causes of neonatal sepsis

pneumonia
meningitis

141

early neonatal sepsis causes

e.coli
listeria

142

late neonatal sepsis causes

e.coli
GBS

143

diagnostic tests for sepsis

- blood and urine culture
- urinalysis
- CXR
- LP

144

tx of neonatal sepsis

ampicillin
gentamicin
cefotaxime (if meningitis)

145

best initial test for toxo

IgM

146

most accurate test for toxo

PCR

147

initial test for rubella

maternal IgM + clinical

148

tx for neonatal rubella

supportive

149

CMV best intiial test

urine or saliva viral titers

150

most accurate test for CMV

urine or saliva PCR for viral DNA

151

tx CMV with end organ damage

ganciclovir

152

week 1 herpes

shock and DIC

153

week 2 herpes

vesicular skin lesions

154

week 3 herpes

encephalitis

155

measles dx

IgM= most accurate

156

emergency tx of croup

racemic epinephrine

157

XR for croup

NEVER the right answer

158

hypoxia on presentation

croup

159

hypoxia imminent

epiglottitis

160

most nb for epiglottitis

intubation

161

CXR for whooping cough

buterfly pattern

162

productive cough lasting 7-10days with fever

bronchitis- clinical dx-supportive tx

163

painful limp + ER leg

SUFE

164

painful limp only

LCP

165

XR LCP vs SUFE

BOTH= widening of joint
LCP----> effusions

166

tx LCP

= rest and NSAIDS
---> SURGERY BOTH HIPS (since if one necroses, likely that the other one will swell)

167

tx for SUFE

IR and pinning

168

burning feet syndrome

vit B5 deficiency

169

random add in for it A deficiency

hypoparathyroidism
thus XS= hyperparathyroidism