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