Pediatrics Flashcards
(271 cards)
1
Q
At delivery, what should a newborn baby receive?
A
- erythromycin ophthalmic ointment
- IM vit K 1mg
2
Q
What does erythromycin ophthalmic ointment protect a newborn from?
A
- Neisseria gonorrhoeae ophthalmia neonatorum
3
Q
If a newborn day 2 infant develops eye issues, what is the most likely cause?
A
- Neisseria gonorrhea
4
Q
What is the tx for neisseria gonorrhoeae ophthalmia neonatorum?
A
- ceftriaxone
5
Q
If a newborn day 7 develops eye issues, what is the most likely cause?
A
- chlamydia trachomatis
6
Q
What is the tx for eye issues in a newborn caused by chlamydia trachomatis?
A
- oral erythromycin
7
Q
Newborn baby of 21 days develops eye issues, what is the most likely cause?
A
- herpes simplex virus
8
Q
A 21 day old infant has herpes simplex virus. What is the tx?
A
- systemic acyclovir and topical vidarabine
9
Q
MOA of erythromycin
A
- inhibits reproduction of bacteria by blocking ribosomal formation
- specifically the 50 S unit
10
Q
MOA of penicillins
A
- inhibit cell fall formation
11
Q
What the vitamin K dependent factors?
A
- 10
- 9
- 7
- 2
- protein C
- protein S
12
Q
Define hemorrhagic disease of newborn
A
- occurs after 24 hours of life
- baby did not have vit K shot, look for a home delivery
- healthy baby who suddenly presents with increased bleeding
13
Q
Why do babies have low vitamin K levels?
A
- Vitamin K does not cross the placenta
14
Q
What are the neonatal screenings required by law?
A
- PKU
- congenital adrenal hyperplasia
- biotinidase
- beta-thalassemia
- galactosemia–> galactase enzyme
- TSH for hypothyroidism
- homocysteine for homocystinuria
15
Q
If the mother was HBsAg negative, what should you give the baby?
A
- hep B vaccine
16
Q
If the mother was HBsAg +, what should you give baby?
A
- hep B vaccine AND IVIG
17
Q
When performing a hearing test on a newborn before discharge, what are you trying to rule out?
A
- congenital sensorineural hearing loss
18
Q
The 1 minute APGAR score indicates?
A
- what is going on with the baby during labor and delivery
19
Q
The 5-minute APGAR score indicates?
A
- the newborn’s response to therapy
20
Q
What does APGAR stand for?
A
- appearance
- pulse
- grimace
- activity
- respirations
21
Q
A mass in the midline that moves with swallowing or tongue protrusion is known as?
A
- thyroglossal duct cyst
22
Q
What causes a thyroglossal duct cyst to form?
A
- from the descent of the primordial thyroid gland at the base of the tongue
23
Q
When do the intestines migrate into the abdomen?
A
- at 10 weeks
24
Q
How would a baby from a diabetic mother present?
A
- large for gestation
- plethora
- jitteriness
- possible complication- shoulder dystocia during delivery
- cardiomegaly
25
Tx for an infant of a diabetic mother
- glucose and small frequent meals
26
What are some abnormalities that may be seen in an infant of a diabetic mother?
- hypoglycemia
- hypocalcemia
- hyperbilirubinemia
- polycythemia
- hypomagnesemia
27
Infant of a diabetic mother is associated with what abnormalities?
- cardiac abnormalities, like ASD, VSD, truncus arteriosus
- small left colon syndrome
- increased risk of developing diabetes and childhood obesity
28
Why are infants of diabetic mothers hypoglycemic at birth?
- they are used to a high glucose environment so their bodies produce more insulin. When they leave the high glucose environment, they are making more insulin than the sugar in their bodies.
29
what is the best initial test for a newborn with respiratory distress?
- cxr
30
A newborn with respiratory distress should have which tests completed?
- cxr
- abg
- blood cultures
- glucose
- CBC
- cranial ultrasound
31
What is the tx for newborn respiratory distress?
- oxygen
- nasal CPAP
- consider empirical antibiotics, if suspecting sepsis
32
If oxygen therapy does not improve the newborn's respiratory distress, what other cause may be the issue?
- cardiac related
33
How will a baby with respiratory distress syndrome present?
- tachypnea
- nasal grunting
- intercostal retractions within hours after birth
- premature infant
34
What would you expect to see on a cxr with an infant of respiratory distress syndrome?
- ground glass appearance
- air bronchograms
- atelectasis
35
what is the best predictive test that a newborn will develop respiratory distress syndrome?
- Lecithin-sphingomyelin ratio on amniotic fluid prior to birth
36
Tx for RDS
- oxygen
- nasal CPAP
- exogenous surfactant (lucinactant)
37
Mechanism of surfactant
- prevents collapse of the alveoli by decreasing surface tension
38
Which cells produce surfactant?
- type II pneumocytes
39
When is enough surfactant produced for the fetus?
- 35 weeks gestation
40
What can be used for preventing respiratory distress syndrome?
- antenatal betamethasone
41
When is betamethasone most effective?
- given 24 hours before delivery
| - before 34 weeks gestation
42
What are possible complications of respiratory distress syndrome?
- retinopathy of prematurity due to hypoxemia
- bronchopulmonary dysplasia due to prolonged high concentration of oxygen
- intraventricular hemorrhage
43
How can you prevent bronchopulmonary dysplasia from occurring in a newborn with respiratory distress syndrome?
- by using a CPAP
44
Define transient tachypnea of the newborn
- tachypnea after birth of an infant delivered by c section or rapid second stage of labor
- most likely caused by retained lung fluid
45
What can you see on an xray in a newborn with transient tachypnea of a newborn?
- air trapping
- fluid in fissures
- perihilar streaking
46
tx for transient tachypnea of a new born?
- oxygen
47
Define meconium aspiration syndrome
- newborn aspirates first stool in utero or at the first postnatal breath causing severe respiratory distress and hypoxemia
48
Meconium aspiration causes
- blockage of alveoli
- decreased gas exchange
- irritation of airway, causing inflammation and then PNA
49
What to look for in a patient with meconium aspiration syndrome on cxr?
- patchy infiltrates
- increased AP diameter aka barrel chest
- flattening of diaphragm
50
Tx for meconium aspiration syndrome
- positive pressure ventilation
- high frequency ventilation
- nitric oxide therapy
- extracorporeal membrane oxygenation
51
What are some possible meconium aspiration complications
- pulmonary artery hypertension
- air leak leading to pneumothorax
- aspiration pneumonitis
52
How can you confirm the diagnosis of tracheoesophageal fistula?
- placement of NG tube
53
A patient with tracheoesophageal fistula may also have other VACTERL abnormalities. What could those be?
- vertebral defects
- anal atresia
- cardiac abnormalities
- esophageal atresia
- renal anomalies
- limb syndrome
54
What is the differential diagnosis for double bubble seen on xray?
- duodenal atresia
- annular pancreas
- malrotation
- volvulus
55
A premature infant takes her first feed and begins vomiting gastric and bilious material. There is a double bubble gas shown on xray. What is the most likely diagnosis?
- duodenal atresia
56
Define annular pancreas
- pancreas surrounds the second part of the duodenum in a ring-like formation, potentially causing obstruction
57
What are some symptoms of annular pancreas?
- polyhydramnios
- low birth weight
- feeding intolerance
58
What is the best initial test for suspected annular pancreas?
- abdominal x-ray
59
What is the most accurate test for annular pancreas?
- abdominal CT scan
60
How does annular pancreas form?
- the ventral bud of the pancreas does not rotate with the duodenum during the 7th week of gestation. This causes encasing of the duodenum.
61
What are tests that need to be ordered when a newborn has jaundice within the first 24 hours of life?
- total and direct bilirubin
- blood type of infant and mother
- direct coombs test
- cbc
- reticulocyte count
- blood smear
- U/A
- urine culture
62
If there is prolonged jaundice for more than 2 weeks and no elevation of conjugated bilirubin, what may be the cause?
- UTI
- bilirubin conjugation abnormalities
- hemolysis
- intrinsic red cell membrane or enzyme defects
63
which enzyme is low in infants, which is why they cannot conjugate unconjugated bilirubin to glucose so that it can be excreted through the feces?
- glucuronosyltransferase
64
If there is prolonged jaundice for more than 2 weeks and elevated conjugated bilirubin, what is the best initial test?
- LFTs
65
After ordering LFTS, what should be ordered in a newborn who has had elevated conjugated bilirubin for >2weeks?
- U/S
| - liver biopsy
66
What are some symptoms of kernicterus?
- hypotonia
- seizures
- opisthotonos
- delayed motor skills
- choreoathetosis
- sensorineural hearing loss
67
What causes kernicterus?
- build up of unconjugated/indirect bilirubin crossing the blood brain barrier and depositing into the brain
68
Tx for kernicterus
- immediate exchange transfusion
| - phototherapy >10-12 mg/dl
69
How does phototherapy help a jaundice baby?
- it causes the bilirubin to become water-soluble
70
Mongolian spots aka?
- congenital dermal melanocytes
71
Further management of congenital dermal melanocytosis
- rule out child abuse
72
Firm, yellow white papules/pustules with erythematous base, which peak on the second day of life is known as
erythema toxicum
73
tx for erythema toxicum
- self limited
74
permanent, unilateral vascular malformations on the head and neck are known as
- port wine stain
75
What are port wine stains associated with?
- Sturge Weber syndrome
76
Define sturge weber syndrome
- AV malformation that results in seizures, mental retardation, and glaucoma
77
Tx for sturge weber syndrome
- anticonvulsants
| - pulsed laser therapy
78
Red, sharply demarcated, raised lesions appearing in the first 2 months, rapidly expanding, and then involuting by 5-9 y/o are known as
- hemangiomas
79
Tx for hemangiomas
- propanolol and or pulsed laser if large or interferes with organ function
80
Preauricular tags/pits are associated with?
- hearing loss
| - GU abnormalities
81
When an infant has preauricular tags or pits, what are the next steps in management?
- hearing test
| - U/S of kidneys
82
Coloboma is associated with which syndrome?
- CHARGE syndrome
83
What does CHARGE syndrome include?
- coloboma
- heart defects
- atresia of the nasal choanae
- growth Retardation
- GU abnormalities
- Ear abnormalities
84
absence of the iris is called?
- aniridia
85
Aniridia is associated with ?
- Wilms tumor
86
How often should a child with aniridia be screened for Wilms tumor?
- via U/S every 3 months until age 8
87
A mass midline of the throat is a thyroglossal duct cyst whereas a mass lateral to the midline is a ?
- branchial cleft cyst
88
Define umbilical hernia
- congenital weakness where vessels of the fetal and infant umbilical cord exited through the rectus abdominis muscle
89
An umbilical hernia is associated with?
- congenital hypothyroidism
90
Define hydrocele
- scrotal swelling with transillumination of the mass
91
A hydrocele is associated with ?
- inguinal hernias
92
Unilateral absence of testes in the scrotal sac is?
- undescended testes
93
What is the definitive tx for undescended testes
- orchiopexy
94
When should orchiopexy be completed?
- >1 year of age
95
How does toxoplasmosis present in a child?
- hydrocephalus with generalized intracranial calcifications and chorioretinitis
96
What makes toxoplasmosis + in a newborn?
+ toxoplasma IgM after 5 days of lifer or + IgA after 10 days of life
97
How does rubella present in a newborn?
- cataracts
- deafness
- heart defects
- blueberry muffin spots
98
What is the diagnostic test for rubella in a child?
- rubella virus RNA by PCR
99
How does CMV present in a newborn?
- microcephaly with periventricular calcifications
- petechiae with thrombocytopenia
- sensorineural hearing loss
- blueberry type rash
100
What is the diagnostic test for CMV in an infant?
- urine or saliva CMV culture; if negative, consider CMV PCR
101
If herpes is present in the first week of life, how will it present?
- pneumonia/shock
102
If herpes is present by the second week of life, how will it present
- skin vesicles
| - keratoconjunctivitis
103
How will herpes present if the infant is 3-4 weeks old?
- acute meningoencephalitis
104
What is the most accurate test for herpes?
- HSV PCR
105
How does syphilis present in an infant?
- osteochondritis
- periostitis
- desquamating skin rash of palms and soles
- snuffles
- hepatomegaly
106
What is the best initial test for syphilis in an infant?
- VDRL screening
107
What is the most accurate test for syphilis?
- IgM-FTA-ABS
108
If an infant develops VZV as a neonate, how will it present?
- PNA
109
If an infant was infected in utero with vZV, how will it present?
- limb hypoplasia
- cutaneous scars
- seizures
- mental retardation
110
What is the best initial test for varicella?
- IgM serology
111
What is the most accurate test for varicella?
- PCR of amniotic fluid
112
Heroin, cocaine, amphetamine, and alcohol withdrawal will present when in a newborn's life? *if mother was on these substances*
- within the first 48 hours
113
If a mother was on methadone while pregnant, when will methadone withdrawal present?
- within the first 96 hours
114
- Methadone withdrawal in infants is associated with a higher risk of ?
- seizures
115
Infants of mothers with substance use disorders are at a higher risk for?
- low birth weight
- intrauterine growth restriction
- congenital anomalies associated with alcohol and cocaine use
- sudden infant death syndrome
116
Why wouldn't you give an infant naloxone if the mother was using opioids?
- could cause sudden withdrawal, which could lead to seizures
117
Anesthetics can cause what to neonates?
- respiratory and CNS depression
118
Barbiturates can cause what to neonates?
- respiratory and CNS depression
119
Magnesium sulfate can cause what to neonates?
- respiratory depression
120
Phenobarbital given to neonates can cause?
- vitamin K deficiency
121
Isotretinoin in neonates can cause?
- facial and ear anomalies
| - congenital heart disease
122
Phenytoin in neonates can cause?
- hypoplastic nails
- typical facies,
- IUGR
123
Diethystilbestrol can cause what in neonates?
- vaginal adenocarcinoma
124
Tetracycline in neonates can cause?
- enamel hypoplasia
| - discolored teeth
125
Sulfonamides in neonates can cause?
- displaces bilirubin from albumin (can lead to increased bilirubin levels)
126
NSAIDS in neonates can lead to ?
- premature closure of ductus arteriosus
127
ACEi in neonates can cause?
- craniofacial abnormalities
128
Lithium can cause what in neonates?
- ebstein anomaly
129
Warfarin in neonates can cause?
- facial dysmorphism
| - chondrodysplasia (bone stippling)
130
Valproic acid and carbamazepine can cause what in a neonate?
- mental retardation
| - neural tube defects
131
What are some classic features of down syndrome (trisomy 21)?
- upward slanting palpebral fissures
- specking of iris aka brushfield spots
- inner epicanthal folds
- small stature
- late fontanel closure
- mental retardation
- hypoplasia of the middle phalanx of the fifth finger
- high arched palate microcephaly
132
What is the workup for a child suspected of trisomy 21?
- hearing exam
- echocardiogram
- TSH
133
What are some characteristics of Edwards syndrome (trisomy 18)?
- low-set malformed ears
- microcephaly
- micrognathia
- clenched hand with index over third, fifth over fourth finger
- rocker bottom feet and hammer toe
- omphalocele
- heart defect most commonly being VSD
134
What is the workup for a child suspected with Edwards Syndrome?
- echocardiogram
| - renal ultrasound
135
What are some characteristics of trisomy 13 aka Patau syndrome?
- defect of midface, eye, and forebrain development
- holoprosencephaly, microcephaly, microphthalmia
- cleft lip/palate
136
Workup for suspected Patau syndrome?
- echocardiogram
| - renal ultrasound
137
What is the presentation of WAGR syndrome?
- wilms tumor
- aniridia
- GU anomalies
- mental Retardation
138
Presentation of klinefelter syndrome?
- low IQ
- behavioral problems
- slim with long limbs
- gynecomastia
139
Workup for suspected klinefelter syndrome?
- testosterone levels
| - genetic test to confirm XXY
140
How does turner syndrome present?
- small stature female
- gonadal dysgenesis
- low IQ
- congenital lymphaedema
- webbed posterior neck
- wide spaced nipples
141
Horseshoe kidney is common in which congenital syndrome?
Turner syndrome
142
Tx for turner syndrome
- estrogen
- growth hormone
- anabolic steroid replacement
143
How does fragile x syndrome present?
- macrocephaly in early childhood
- large ears
- large testes
- mental retardation
144
Children with beckwith-wiedemann syndrome are at risk for ?
- WIlms tumor
| - hepatoblastoma
145
Presentation of beckwith-wiedemann syndrome
- multiorgan enlargement, such as macrosomnia, macroglossia, pancreatic beta cell hyperplasia, large kidneys, neonatal polycythemia
146
What should be done to look for wilms tumor and hepatoblastoma in a child with Beckwith-Wiedemann syndrome?
- obtain U/S and serum AFP every 6 months through age 6
147
Presentation of prader-willi syndrome
- obesity
- mental retardation
- binge eating
- small genitalia
148
Presentation of angelman syndrome
- mental retardation
- inappropriate laughter
- absent speech or <6 words
- ataxia
- jerky arm movements
- seizures
149
Presentation of robin sequence aka pierre robin
- mandibular hypoplasia
| - cleft palate
150
What should be monitored in a child with robin sequence?
- airway--> obstruction is possible over the first 4 weeks of life
151
Trisomy is most commonly caused via?
- nondisjunction during meiosis
152
What is the gene responsible for Marfan syndrome
- FBN1 gene on chromosome 15
153
Presentation of Marfan syndrome
- thin patient with long extremities
- arachnodactyly
- pectus excavatum deformity
- hypermobile joints
154
Most accurate test for Marfan syndrome
- genetic testing
155
A common complication later in life in those with Marfan syndrome is?
- aortic root dissection
156
At the first diagnosis of Marfan syndrome, what test should be done?
- TTE to look at the aortic root to make sure it is stable
157
What are some features of ehlers-danlos syndromes?
- extremely elastic, smooth skin that is fragile and bruises easily
- wide, atrophic scars
- joint hypermobility
- molluscoid pseudotumors (calcified hematomas over pressure points such as the elbow)
- spheroids
(fat containing cysts on forearms and shins)
- hypotonia and delayed motor development
158
How to diagnose Ehlers-Danlos Syndromes?
- genetic testing or skin biopsy
159
What are some features of osteogenesis imperfecta?
- recurrent fractures
- osteopenia
- joint laxity
- blue sclerae
- hearing loss
- progressive skeletal deformity
160
What is the most common form of osteogenesis imperfecta?
- AD encoding of the alpha1 and 2 chains of type I collage (COL1A1 and COL1A2)
161
Child has moro grasp, rooting, tonic neck, and placing reflexes. When do they disappear?
4-6 months of age
162
What is the parachute reflex?
- extension of arms when fall simulated
163
When does the parachute reflex become present?
6-8 months
164
The social smile is common at what age?
2 months
165
At 4 months, what would you expect the infant to be able to do?
- lift head
- tracks past midline
- coos
- social smile
- rolls front to back and back to front
- grasps a rattle
- orients to voice and can laugh
166
When is stranger anxiety present?
by 6 months
167
What are new skills developed by a 6 month infant?
- can sit unassisted
- transfer objects between hands
- can babble
168
When would a child be expected to know his or her name?
at 9 months
169
What new skills does a 9 month learn?
- pincer grasp
| - creeps and crawls
170
By what age should a child know a 1 to handful of words?
- 12 months
171
When can a child start to walk?
12 months
172
What new skills can a 15 month old do?
- build a tower of 3 cubes
- walk alone
- make lines and scribbles
173
When can a child start to feed themselves?
18 months
174
When can a child be expected to start speaking in sentences?
- 24 months
175
When does a child recognize what age and gender they are?
- 36 months
176
When does a child start to participate in group child play?
- 48 months
177
When can a child hop on 1 foot?
- 48 months
178
When does birth weight about double?
- 4 months
179
When does birth weight triple?
- 1 year
180
What is the best indicator for acute malnutrition?
- weight and or height <5th percentile
181
What is the best indicator for under and overweight children?
- BMI
182
Skeletal maturity of a child is related to ____ and not chronologic age.
- sexual maturity
183
Child has decreased weight gain greater than decreased height. What is the differential?
- undernutrition
- inadequate digestion
- malabsorption
184
How to work up a child with decreased weight gain greater than decreased height?
- assess caloric intake
- perform stool studies for fat
- perform sweat chloride test
185
A child with normal weight gain but decreased height for their age, what is the differential?
- GH or TH deficiency
- excessive cortisol secretion
- skeletal dysplasias
186
Work up for a child with normal weight gain but decreased height.
- TSH
- Insulin-like growth factor 1 and IGF-binding protein 3
- xray of hand and wrist to get bone age
187
A child has decreased weight gain equal to decreased height for their age. What is the differential?
- systemic illness
- genetic short stature
- constitutional delay in growth and development
188
Workup for a child with decreased weight gain equal to decreased height
- CRP
- ESR
- CBC with diff
- CMP
- xray of hands and wrist to get bone age
189
Define genetic short stature
- bone age is close to chronological age
| - puberty occurs at a normal time
190
Define constitutional delay of growth
- bone age is delayed and puberty occurs later than usual
191
What is the first antibody secreted in a child?
- IgM
192
What is the only antibody to cross the placenta and therefore giving sustained immunity to pathogens?
- IgG
193
WHich antibody binds to allergens and secretes histamine?
- IgE
194
Where is IgA found?
- mucosal areas, such as intestines, saliva, tears, breast milk
195
Bedwetting is normal up to what age?
- 5
196
define enuresis
- involuntary voiding of urine at least 2x/weel for the last three months in children >5
197
Tx for noturnal enuresis
- behavior therapy
198
Diurnal enuresis is associated with a higher rate of ____
- UTIs
199
A child coming to the clinic for enuresis should have what as the initial test completed?
- U/A
200
A child with recurrent UTIs should have what completed?
- renal/bladder U/S
201
If behavioral therapy fails to treat the enuresis, what is the next step?
- desmopressin to decrease the amount of urine produced
202
What is the age that most children control their bowel movements?
- 4
203
What is the best initial test for a child with encopresis?
- abdominal xray
204
Retentive encopresis is associated with ?
- constipation and overflow incontinence
205
Nonretentive encopresis is associated with?
- abuse
206
Tx for retentive encopresis
- disimpaction
- stool softeners
- behavioral intervention
207
Tx for nonretentive ecopresis
- behavior modification alone
208
Criteria to diagnose a child <17 with ADHD
- they must have at least 6 symptoms of hyperactivity and impulsivity
- or at least 6 symptoms of inattention
209
Criteria to diagnose patients >17 with ADHD
- they must have at least 5 symptoms of hyperactivity and impulsivity
- or at least 5 symptoms of inattention
210
All ages for ADHD diagnosis criteria are?
- occur in more than one setting and often
- start before age 12 and last at least 6 months
- impair the child's function
- be excessive for the child's developmental status
211
What are some symptoms of inattention
- distraction
- inability to follow directions
- inability to complete a task
- daydreaming
- inability to stay organized
- carelessness
212
What are some symptoms of hyperactivity?
- fidgeting
- excessive talking
- constant physical motion
- inability to sit still
213
What are some symptoms of impulsivity?
- blurting out answers
| - inability to wait their turn
214
What are some behavioral modifications to help children with ADHD?
- maintaining the same daily schedule
- using checklists and star charts for tasks
- keeping distractions to a min
- rewarding positive actions
215
First line tx for ADHD
- methyphenidate
216
What are some contraindications to immunize?
- reaction to previous DPT with redness, soreness, and swelling
- mild acute illness in an otherwise healthy child after vaccine
- family hx of seizures or SIDS
- egg allergy for MMR, yellow fever vaccine
217
What is the recommendation for a patient with an egg allergy to have the flu vaccine?
- patients older than 6 months with a known egg allergy should receive trivalent inactivated influenza vaccine followed by 30 minutes of observation in a facility prepared to recognize and treat anaphylaxis
218
Post exposure protocol for measles
- patient 0-6 months gets Ig
- 6-12 months gets Ig + vaccine
- >12 months gets vaccine only within 72 hours of exposure
- pregnant or immunocompromised patient gets Ig ONLY
219
Post exposure protocol for varicella
- children and household contacts get Ig and vaccine
- susceptible pregnant women and newborns whose mothers had chickenpox within 5 days before and 2 days after delivery get ig ONLY
220
Post exposure protocol for hepatitis B
- Ig + vaccine at birth, 1 month, and 6 months
221
Post exposure protocol for hepatitis A
- age >2 gets Ig + vaccine
222
Routine protocol for hepatitis B vaccine
- if mother is negative for the antigen, the first dose is at birth and then a total of 3 doses by 18 months
- if the mother positive for the antigen, the first dose plus hep B Ig at two different sites within 12 hours of birth with a total of 3 doses by 6 months
223
Routine protocol for DTaP
- 5 doses before school entry
| - Td is given at 11-12 y/o then every 10 years after that
224
The HiB conjugated vaccine does not cover?
- nontypeable Haemophilus
225
What is the age range recommendation for HPV vaccine
13-45
226
Workup for suspected child abuse
- PT
- PTT
- platelets
- CBC
- skeletal survey
227
If a child has severe injuries, what should be conducted?
- head ct scan
228
If a child has abdominal trauma due to abuse, what is the work up
- urine and stool for blood
- LFTs
- lipase and amylase
- abdominal CT
229
In infant abuse, what is important to check?
- dilated eye exam by an ophthalmologist
230
If parents of suspected child abuse refuse hospitalization for their child, what is the next step?
- get an emergency court order
231
X-ray appearance of ewing sarcoma
- onion-skin pattern due to lesions causing laminar periosteal elevation
232
What translocation is common with ewing sarcoma?
t11;22
233
What does the x-ray appearance look like for osteogenic sarcoma?
- sclerotic destruction causing a sunburst appearance
234
What does an osteoid osteoma look like on x-ray?
- round central lucency with a sclerotic margin
235
Most accurate test for osteogenic sarcoma?
- ct scan
236
Most accurate test for osteoid osteoma?
- ct or MRI
237
Tx for osteoid osteoma?
- NSAIDs; condition will resolve spontaneously
238
Which test will seal the diagnosis for mononucleosis!
Mono spot test or heterophil antibody test
239
In a febrile child, you should always check _____ for proper ventilation.
Pulse ox
240
Which two labs will be slightly elevated in mono? * on CMP
ASTs and ALTs
241
When advising patients on CCS, you must order it! Patient is a child who is febrile. Which medication should be avoided?
Why?
Aspirin
It can cause Reye’s syndrome
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What is Reye’s syndrome?
Hepatic encephalopathy in a child from taking aspirin
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How does gonorrhea attach to tissues?
- has pili that acts as a hook
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Pharmacokinetics of erythromycin
- demethylation in the liver
| - works through the CYP450 system
245
MOA of vit K
- adds a carboxyl group to glutamate
246
Which has more vit K: formula or breast milk?
- formula
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What are the absolute contraindications to breast feeding?
- Mom has HIV
- Mom has herpes active infection on the nipple
- Mom has TB
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Define cephalohematoma
- hemorrhage collection on the outside of the skull
| - most common with vacuum-assisted deliveries
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A baby with a cephalohematoma is at an increased risk of ?
- jaundice--> there is more blood that needs to be broken down
250
Patient with acute chest syndrome should be given ____
Hydroxyurea
251
MOA of hydroxyurea
Increases the fetal hemoglobin so that the RBCs don’t sickle as much
252
Patients in a sickle cell crisis due to an infection should be given what type of antibiotic for coverage?
Cephalosporin… ceftriaxone is a third gen so has both positive and negative gram coverage
253
Define dactylitis
Aka hand foot syndrome…. Swelling of the dorsum of the hands or feet associated with pallor and fever
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Any child with sickle cell with a fever should receive?
IV fluids for hydration and empirical antibiotic therapy
*always get the blood culture BEFORE you give antibiotics
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Prophylactic ____ should be give to children over 8 with sickle cell disease
Penicillin
256
One way to help keep the Hemoglobin S less than 30% in sickle cell patients is by
Providing indefinite blood transfusion every 2-4 weeks depending on morbidity
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Breastfeeding jaundice is secondary to?
- decreased milk production during the first week of life
258
What are some risk factors for hyperbilirubinemia?
- jaundice in the first 24 hours of life
- ABO incompatibility
- cephalohematoma
- previous sibling needing phototherapy
- exclusive breastfeeding
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What is the difference between the direct and indirect coombs tests?
- direct coomb's test looks for antibodies on the RBCs
| - indirect coomb's test looks for antibodies in the serum (antibodies will attack other RBCs with those antigens)
260
What is the mechanism of G6PD deficiency?
- loss of production of glutathione reductase
- causes insufficient reducing capacity of RBCs
- produces Heinz bodies
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What vaccines are given at 2, 4, and 6 months of age?
- DTap
- HiB
- polio
- pneumococcal
- rotavirus
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When is hepB vaccines given to children?
- birth
- 1-2 months
- 6 months to 1 year
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First line for a 2month old infant who developed a fever after vaccine?
- tylenol
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What age can children start receiving NSAIDs?
- 6 months and older
265
Define bronchiolitis
- inflammation of the small airways
| - most common cause of respiratory issues in children 3-6 months of age
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The most common cause of bronchiolitis in children is?
- RSV
267
Which children should receive the monoclonal antibody for RSV (Palizivumab)?
- premature infants
- infants with congenital heart disease
- infants with bronchopulmonary disease
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Initial antibiotic choice for children 5< with pneumonia
- macrolides like azithromycin
269
What is the main issue in cystic fibrosis?
- there is loss of flow of chloride and water across the membranes, which then causes clogged lungs, pancreas, and GI tract * mucus stays put
270
Children 6 > can have which drug for cystic fibrosis?
- ivacaftor
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What are the indications for tympanostomy tubes?
- children with more than 3 episodes of otitis media in 6 months or children with 4 or more episodes in 1 year
