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Pediatric Flashcards

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1
Q

Normal RR and HR in a newborn

A

RR 40-60 bpm

HR 120-160 bpm

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2
Q

What does APGAR stand for?

A

Appearance

Pulse

Grimace

Activity

Respiration

Apgar delineates a quantifiable measurement for the need and effectiveness of resuscitation; does not predict mortality.

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3
Q

Most common cause of conjunctivitis in a newborn at:

1 day

1 week

2 weeks

1 month

A

1 day: chemical irritation (silver nitrate)

2-7 days: N gonorrhea (prevent with ointments, treat with ceftriaxone)

>7 days: Chlamydia (not effectively prevented by ointments, treat with oral erythromycin)

>3 weeks: herpes (treat with systemic acyclovir and topical vidarabine)

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4
Q

What steps do we take to prevent ophthalmia neonatorum

A

2 types of antibiotic drops in each eye:

Erythromycin or tetracycline ointment

Silver nitrate solution

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5
Q

What causes Vit K deficiency in newborns and how do we prevent it?

A

Immature livers do not utilize vitamin K to develop appropriate clotting factors; E coli is not present in sufficient quantities to make enough vitamin K

To prevent VKDB a single IM dose of vitamin K is recommended

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6
Q

Which children should get HBIG in addition to a hepatitis B vaccine

A

THose with HBsAg-positive mothers

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7
Q

Explain transient polycythemia of the newborn

A

Hypoxia during delivery stimulates EPO

Splenomegaly is a normal finding

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8
Q

Explain transient tachypnea of the newborn

A

Newborns delivered via C/S may have excess fluid in the lungs and therefore by hypoxic

If tachypnea lasts more than 4 hours, it is considered sepsis and must be evaluated with blood and urine cultures

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9
Q

Why are over 60% of newborns jaundiced?

A

Infant’s spleen removing excess RBCs that carry Hgb F

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10
Q

What puts infants at risk for subconjunctival hemorrhage

A

Minute hemorrhages may be present in the eyes of the infant due to a rapid rise in ICP as the chest is compressed while passing through the birth canal

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11
Q

3 major types of skull fractures in the newborn

A
  1. Linear: most common
    2: Depressed
  2. Basilar: most fatal
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12
Q

Difference between caput succedaneum and cephalohematoma?

A

Caput: swelling of the soft tissues of the scalp that DOES CROSS suture lines

Cephalo: subperiosteal hemorrhage that DOES NOT CROSS suture lines

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13
Q

Infant unable to abduct the shoulder or externally rotate and supinate the arm

A

Duchenne-Erb Paralysis: C5-C6

“Waiter’s tip” appearance 2/2 shoulder dystocia

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14
Q

Paralyzed hand with ptosis, miosis, and anhydrosis

A

Klumpke Paralaysis: C7-C8 +/- T1

“Claw hand” d/t lack of grasp reflex

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15
Q

What is the most common cause of Facial Nerve Palsy

A

trauma 2/2 forcep use in delivery

surgical repair is necessary if improvement is not seen over a few weeks

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16
Q

Neurological Werdnig-Hoffman

A

Infant is unable to swallow, leading to polyhydramnios

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17
Q

2 types of diaphragmatic hernias

A

Morgagni: defect is retrosternal or parasternal

Bochdalek (most common): defect is posterolateral and commonly occurs on the left side

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18
Q

What is an omphalocele highly associated with?

A

Edwards syndrome (trisomy 18)

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19
Q

What is an umbilical hernia highly associated with?

A

Congential hypothyroidism

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20
Q

WAGR syndrome

A

Wilms tumor

Aniridia (absence of an iris)

Genitourinary malformations

mental Retardation

Syndrome results from a deletion on chromosome 11

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21
Q

Most common cancer in infancy

A

Neuroblastoma (adrenal medulla tumor)

Look for hypsarrhythmia (on EEG) and opsomyoclonus (dancing eyes dancing feet)

Look for increased VMA and metanephrines on urine collection

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22
Q

Remnant of the tunica vaginalis that transilluminates upon inspection

A

Hydrocele (usually resolves within 6 months)

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23
Q

What should you do if you find a varicocele?

A

Ultrasound the other testicle (varicocele is a bilateral disease)

Treatment is indicated for delayed growth of the testes or in those with evidence of testicular atrophy

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24
Q

Exercise intolerance and squatting while playing outside

A

pathognomonic for tetralogy of Fallot

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25
Most common cyanotic heart defect in children
TOF: overriding aorta, pulmonary stenosis, RV hypertrophy, VSD Associated with chromosome 22 deletions
26
CXR: boot-shaped heart
TOF
27
Only 3 holosystolic murmurs
1. Mitral regurgitation 2. Tricuspid regurgitation 3. VSD
28
The most common congenital heart defect in Down Syndrome
endocardial cushion defect of atrioventricular canal (walls separating all 4 chambers are poorly formed or absent)
29
CXR: egg on a string
Transposition of the Great Vessels No oxygenation of blood can occur without a PDA, ASD, or VSD
30
Most common cyanotic condition in neonates vs children
Neonates = TOGV Children = TOF
31
CXR: globular-shaped heart
Hypoplastic left heart syndrome
32
Treatment for truncus arteriosus
Surgery must be done early to prevent pulmonary hypertension
33
CXR: snowman or figure 8 sign
Total anomalous pulmonary venous return (TAPVR): oxygenated blood returns to the SVC TAPVR with obstruction would just show pulmonary edema on CXR and present early in life with respiratory distress and severe cyanosis
34
Holosystolic murmur + FTT
VSD Common in Down, Edwards, and Patau
35
3 major types of ASD
1. Primum defect (concomitant mitral valve abnormalities) 2. Secundum defect (most common) 3. Sinus venosus defect (least common) Look for paradoxical emboli from deep leg veins
36
fixed wide splitting S2
ASD
37
Machine-like murmur Wide pulse pressure Bounding pulses
PDA Normal finding in the first 12 hours, after 24 hours it is considered pathologic
38
Mitral lesions radiate to... Tricuspid/pulmonary lesions radiate to... Aortic lesions radiate to...
Mitral = Axilla Tricuspid/pulmonary = Back Aortic = Neck
39
CXR: pear-shaped heart
pericardial effusion
40
CXR: "3-sign" or rib notching
coarctation of the aorta associated with Turner Syndrome (short girl with webbed neck, shield chest, streak gonads, horseshoe kidneys, or shortened fourth metacarpal)
41
Hearing loss Syncope Normal vitals/exam FHx of sudden cardiac death
Long QT Syndrome
42
When is hyperbilirubinemia considered pathologic?
- first day of life - rises more than 5 mg/dL/day - above 19.5 mg/dL - direct rises above 2 mg/dL - persists after the second week of life
43
Hypotonia Seizures Choreoathetosis Hearing loss
Kernicterus *Choreoathetosis: occurrence of involuntary movements in combination with chorea (irregular migrating contractions) and athetosis (twisting and writhing)*
44
Vomiting with first feeding
TEF Likely be a history of polyhydramnios; look for recurrent aspiration pneumonia
45
Nonbilious projectile vomiting with "olive sign"
Pyloric stenosis (most common cause is idiopathic)
46
Lab changes seen with vomiting
Hypochloremic, hypokalemic metabolic alkalosis Due to loss of hydrogen ions in the vomitus; potassium loss also worsens from aldosterone release in response to hypovolemia Look for "string sign" on upper GI series
47
CHARGE Syndrome
C: coloboma of the eye (hole), CNS anomalies H: heart defects A: atresia of the choana (prevents breathing during feeding) R: retardation of growth/development G: genital and/or urinary defects (hypogonadism) E: ear anomalies and/or deafness
48
Hirschsprung disease, Imperforate anus, and Duodenal atresia are associated with
Down Syndrome
49
VACTERL Syndrome
V: vertebral anomalies A: anal atresia C: CV anomalies T: TEF E: esophageal atresia R: renal anomalies L: limb anomalies
50
Duodenal atresia is caused by
a lack or absence of apoptosis (improper canalization of the lumen)
51
upper GI series showing "bird beak" appearance
Volvulus (majority being in the ileum)
52
Most important step for intussusception
Fluid resuscitation and balancing of electrolytes, followed by NGT decompression of the bowel Air/Barium enema is both diagnostic and therapeutic (can be attempted 3 times before surgical intervention is required)
53
painless BRBPR
Meckel's diverticulum (technetium 99 scan) Rules of 2's: 2% of the population, 2 feet of ileocecal valve, 2 types of tissue (gastric and pancreatic), age \< 2, males 2x more affected, symptomatic in 2% of patients, 2 inches long
54
Abdominal XR showing air within the bowel wall
AKA pneumatosis intestinalis *Pathognomonic for necrotizing enterocolitis - seen in premature infants where the bowel undergoes necrosis and bacteria invade the intestinal wall*
55
Unique findings in infants of diabetic mothers (IDMs)
Small Left Colon Syndrome Cardiac Abnormalities Renal Vein Thrombosis Metabolic Findings and Effects Macrosomia (all organs enlarged except for the brain) **S**ugar **C**an **R**eally **M**ake **M**istakes
56
What is common among all forms of Congenital Adrenal Hyperplasia?
Low cortisol, High ACTH, Low aldosterone 21 = relatively low BP, increased androgens 11 = increased BP, increased androgens 17 = increased BP, decreased androgens
57
3 main etiologies of rickets
1. Vitamin D-deficient 2. Vitamin D-dependent (inability to convert 25-OH to 1,25(OH)2) 3. X-linked hypophosphatemic
58
Most common causes of neonatal sepsis
Pneumonia and Meningitis Most common organisms: GBS, E coli, S aureus, Listeria Treatment: Ampicillin and gentamicin (+/- cefotaxime)
59
Chorioretinitis, hydrocephalus, and multiple ring-enhancing lesions
Toxoplasmosis Look for elevated IgM (PCR is most accurate test) Treat with pyrimethamine and sulfadiazine
60
Rash on palms/soles, snuffles, 8th nerve palsy, and saddle nose
Syphilis VDRL or RPR (dark field microscopy is most accurate) Treat with penicillin
61
PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, hyperbilirubinemia
Rubella Supportive care
62
Periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae
**CMV** Urine or saliva viral titers (most accurate test is PCR) **Treat with ganciclovir** when signs of end organ damage are present
63
Best initial test for Herpes
Tzanck smear (PCR is most accurate) Treat with acyclovir and supportive care Week 1: shock and DIC Week 2: vesicular skin lesions Week 3: encephalitis
64
Pruritic vesicular rash that begins on the face; possible fever and malaise
Varicella Tzanck smear showing multinucleated giant cells
65
Cough, Coryza, and Conjunctivitis with a Koplik spot (grayish macule on buccal surface)
Measles (rubeola)
66
Starts with fever and URI and progresses to rash with "slapped cheek" appearance
5th disease (parvovirus B19)
67
Fever and URI progressing to diffuse rash
Roseola
68
Fever precedes classic parotid gland swelling and possible orchitis
Mumps
69
Fever Pharyngitis Sand-paper rash over trunk and extremities Strawberry tongue Cervical lymphadenopathy
Scarlet Fever Treat with penicilin, azithromycin, or cephalosporins
70
Severe cough Fever Coryza Inspiratory stridor CXR: steeple sign
Croup (most commonly caused by parainfluenza virus types 1 and 2; RSV is the second most common cause)
71
Treatment for mild croup vs moderate-severe
Mild = steroids Moderate-severe = racemic epinephrine to prevent asphyxiation and probable tracheostomy *Croup will show hypoxia on presentation while epiglottitis is worrisome for imminent hypoxia*
72
Hot potato voice Fever Drooling in a tripod position Refusal to lie flat
Epiglottitis (due to H influenza type B) CXR (not the right answer) would show a "thumbprint sign" Intubate in the OR, administer ceftriaxone for 7-10 days, and give rifampin to all close contacts
73
Stages of Whooping cough
Form of bronchitis caused by Bordetella pertussis **\*Catarrhal stage**: severe congestion and rhinorrhea (14 days) **Paroxysmal stage**: severe coughing episodes with inspiratory whoop followed by vomiting (14 - 30 days) **Convalescent stage**: decrease of frequency of coughing (14 days) \*Erythromycin or azithromycin are only useful in the catarrhal stage Give macrolides to all close contacts
74
Treatment for congenital hip dysplasia
Pavlik harness
75
Treatment for Legg-Calve-Perthes disease
Rest and NSAIDs Follow with surgery on both hips: if one necroses, eventually the other one will
76
Treatment of SCFE
Internal fixation with pinning (don't let them walk out of the exam room)
77
Poor night vision Hypoparathyroidism
Vitamin A deficiency Vitamin A toxicity = pseudotumor cerebri and hyperparathyroidism
78
Beriberi Wernicke's encephalopathy
Vitamin B1 (thiamine) deficiency
79
Angular chelosis Stomatitis Glossitis
Vitamin B2 (Riboflavin) deficiency
80
Diarrhea Dermatitis Dementia Death
Vitamin B3 (Niacin) deficiency
81
Burning feet syndrome
Vitamin B5 (panthothenic acid) deficiency
82
Peripheral neuropathy Must be given with INH
Vitamin B6 (pyridoxine) deficiency
83
Megaloblastic anemia Hypersegmented neutrophils
Vitamin B9 (folate) deficiency
84
Megaloblastic anemia Hypersegmented neutrophils Peripheral neuropathy of the dorsal column tracts
Vitamin B12 (cyanocobalamin)
85
Echymoses Bleeding gums Petechiae
Vitamin C deficiency
86
Rickets in children
Vitamin D deficiency Vitamin D toxicity = hypercalcemia, polyuria, polydipsia
87
Increased prothrombin time/INR Mild to severe bleeding
Vitamin K deficiency

Step 2 CK (18 decks)

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