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Pediatrics > Peds1 > Flashcards

Peds1 Flashcards

1
Q

What are the parts of calculating an APGAR score?

A

Appearance, Pulse, Grimace, Activity, Respiration

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2
Q

When are APGAR scores calculated?

A

1 and 5 minutes

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3
Q

If an infant has a low pulse and respiratory difficult after 30 seconds, what should be done?

A

Positive pressure ventilation

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4
Q

What is the oxygen saturation goal at 1, 5, and 10 minutes after birth?

A

1 min: 60-65%
5 min: 80-85%
10 min: 85-95%

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5
Q

When would a newborn need chest compressions?

A

if their pulse is below 60

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6
Q

What is the most common complication of meconium presentation in the umbilical fluid?

A

meconium aspiration causing severe pulmonary complications

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7
Q

What “shots and drops” should be given to a newborn?

A
  • Vitamin K to prevent hemorrhage
  • Hepatitis B vaccination
  • Chlmydial conjunctivitis
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8
Q

A single umbilical artery would make you consider what abnormality?

A

renal a genesis of IL kidney

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9
Q

How would you differentiate between a cephalohematoma and a caput succedaneum?

A

A caput succedaneum would cross suture lines

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10
Q

What is the cause of transient tachypnea of the newborn?

A

failure to resorb pulmonary fluid during transition to life

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11
Q

What would the CXR of an infant with TTN look like?

A

“wet” lungs that are hyperextended with perihilar streaking in the interlobular fissures

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12
Q

What infants are at an increased risk of TTN?

A

Large infants and C-section babies

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13
Q

What is the cause of IRDS?

A

lack of surfactant production preventing alveoli distension

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14
Q

What infants are at an increased risk for IRDS?

A

premature infants

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15
Q

What would the CXR of an infant with IRDS look like/

A

Uniform granular, ground glass appearance .Air bronchograms.

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16
Q

What is considered “low glucose” in a newborn?

A

<40-45

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17
Q

What are the risk factors for hypoglycemia?

A

LGA, SGA, Infant of a diabetic mother, IUGR

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18
Q

What are some symptoms an infant suffering from hypoglycemia might exhibit?

A

jitteriness, tremors, lethargy, poor feeding

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19
Q

How would you handle an infant with a blood glucose reading of 30?

A

If asymptomatic: feed and recheck

If symptomatic: given 2 ml?kg of D10W and recheck

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20
Q

How does bronchopulmonary dysplasia develop?

A

its a chronic consequence of IRDS causing scarring of the lungs

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21
Q

What is the diagnostic criteria for BPD?

A

an infant born with IRDS that continues to require supplemental oxygen at 28 days of life.

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22
Q

What causes retinopathy of prematurity?

A

premature birth stops the vascularization of the retina, but the capillaries still continue to grow resulting in neovascularization.

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23
Q

What worsens retinopathy of prematurity?

A

excessive oxygen

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24
Q

What are the exam findings of retinopathy of prematurity? How is it treated?

A
  • scarring, distortion, and retinal detachment

- laster photocoagulation

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25
Q

When does the germinal matrix involute? What happens if an infant is born prior to that involution?

A
  • 34 weeks

- infant is susceptible to IVH from minor BP changes

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26
Q

What is the screening test for IVH?

A

cranial ultrasound

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27
Q

What are the worse prognoses associated with IVH?

A

MR, CP, and seizures

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28
Q

In an premature infant with a bloody bowel movement, what would be the first thing to check for?

A

X-ray shows pneumatosis intestinalis (air in the bowel wall)

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29
Q

What is the treatment for necrotizing enterocolitis?

A

NPO, IV antibiotics, and TPN

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30
Q

A child is presenting for a WCC. On exam you note that the child smiles when she sees your face. She is cooing and babbling. When you move across the room you notice she lifts her head to track you. How old is this child?

A

2 months

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31
Q

A 4 month old male presents for a WCC. He is laughing and squealing. He is smacking around for a toy and is able to lift it to his mouth. He follows his Mom around the room with his eyes. What gross motor skill should you test for?

A

Ability to roll over

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32
Q

When does stranger anxiety occur? Separation anxiety?

A

6 months; 1 year

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33
Q

A pincer grasp is a characteristic fine motor skill of this age group?

A

1 year old

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34
Q

A 2-year old follows the rule of 2’s developmentally. What does this include?

A

2-words
2-step commands
Steps

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35
Q

If a child can hop, what age would this occur at?

A

4 years

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36
Q

When is strabismus normal?

A

until 3 months of age

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37
Q

What things could leukocoria indicate?

A
  • retinoblastoma
  • congenital cataracts
  • ROP
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38
Q

What are the signs and symptoms in an infant with lead poisoning?

A

Irritability, headache, hyperactivity, anorexia, intermittent abdominal pain, peripheral neuropathy, acute encephalopathy.

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39
Q

A peripheral smear of a patient with lead poisoning would show?

A

microcytic, hypochromic anemia with basophilic stippling

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40
Q

What vaccinations are given at 2, 4, and 6 months?

A

DR. HHIP

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41
Q

You are seeing a 4-year old in the ED who recently immigrated from Africa. The child was brought in with a 103 degree fever and difficulty breathing. On exam it is noted that the child has a grey pseudomembrane fixed to the pharynx. What is the diagnosis? what is the treatment?

A

Dx: Diphtheria
Tx: secure the airway, antibiotics, antitoxin

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42
Q

If an 8-year-old presents with a nail in the bottom of their foot from walking in a creek bed, what tetanus coverage should be provided?

A

Tdap and TIG

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43
Q

What are the three stages of a pertussis infection?

A

Catarrhal stage is inconspicuous and at the highest risk of transmission

Paroxysmal phase has whooping cough and post-tussive emesis

Resolution phase has regular cold symptoms

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44
Q

What vaccine is contraindicated in patients with egg allergy?

A

Yellow fever

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45
Q

What is the treatment for pertussis?

A

Erythromycin

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46
Q

What is the only absolute CI to the DTaP vaccination?

A

recent encephalopathy

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47
Q

What is the most common adverse reaction to HPV vaccine?

A

syncope

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48
Q

What risk might be increased with RSV vaccine?

A

intussusception

49
Q

Where are the lesions of scabies typically located?

A

webs of hands and genitalia

50
Q

If the HIV status of a mom is unclear, what should you do?

A

Give the mom AZT prior to delivery

51
Q

How do you test an infant for HIV?

A

DNA PCR (mom’s antibodies make babies ELISA false positive)

52
Q

What three infectious agents are specific to newborns?

A

E. coli, Listeria, GBS

53
Q

At what age can you start using Ceftriaxone? What would happen if it was used prior to that?

A

> 1 month of age

Hyperbilirubinemia

54
Q

What is the major side effect of erythromycin in young children?

A

pyloric stenosis

55
Q

What antibiotic coverage is used to treat Listeria?

A

Ampicillin

56
Q

Meningitis with a rash covering the palms and soles is from this bacteria?

A

Nisseria meningitis

57
Q

An encephalitis that presents with BL paralysis?

A

West Nile

58
Q

What is the empiric treatments for meningitis in children?

A

neonates: ampicillin plus cefotaxime or gent

Older children: ceftriaxone and vanc.

59
Q

What are signs of meningitis in neonates?

A

lethargy, poor tone, vomiting, bulging anterior fontanelle

60
Q

A arthrocentesis of an infected joint in a teenage male that shows a WBC of 65, 000 is likely due to?

A

Gonorrhea

61
Q

If a mom has active TB during delivery, what should be done for the newborn?

A

Isoniazid and Vitamin B6

62
Q

What are the symptoms of Parvovirus B19 in each of the following groups: congenital, children, sickle cell, adults?

A

Congenital-hydrops fetalis

Children-“slapped cheek” rash that is itchy and worsens in the sun.

Sickle cell-aplastic crisis

Adults-arthritis

63
Q

What is the cause of the measles? what are the five classic symptoms?

A

Parayxovirus

Rash that starts on the face and spreads to the toes that presents with a fever. Plus, a prodrome of Cough, coryza, conjunctivitis, and Koplik spots

64
Q

What is the lethal complication of the measles?

A

subacute sclerosing panencephalitis

65
Q

What is the prodrome present in Rubella?

A

tender generalized lymphadenopathy

66
Q

How does Rubella present in adolescents?

A

polyarthritis

67
Q

What is the big differentiating factor between the Measles and Roseola?

A

Measles: fever starts with rash. Rash spreads from head down.

Roseola: fever breaks when rash starts. Rash starts on trunk and spreads to face.

68
Q

What is the major complication of Roseola?

A

Febrile seizure during the prodrome phase

69
Q

When is the chicken pox no longer contagious?

A

When the final lesion crusts over.

70
Q

What are the symptoms of mumps?

A

BL parotid swelling and BL orchitis

71
Q

What causes “hand, foot, and Mouth”?

A

Coxsackie virus A

72
Q

What types of lesions does coxsackie virus A cause?

A

vesicular

73
Q

Neural tube defects are most commonly caused by?

A

maternal folate deficiency

74
Q

Chiari II malformation will present with?

A

Myelomeningocele, Upper extremity weakness, respiratory symptoms

75
Q

When do you correct a cleft lip? A cleft palate?

A

Lip at 10-12 weeks and palate at 10-12 months

76
Q

What is normal adult hemoglobin composed of?

A

two alpha and tow beta subunits.

77
Q

What is the physiologic defect that causes sickle cell?

A

Glutamine to valine substitution at the 6th position on the beta chain causes the hemoglobin to sickle.

78
Q

How is sickle cell diagnosed?

A

On prenatal screen or on hemoglobin electrophoresis (also determines severity)

79
Q

How is it determined whether or not a sickle cell patient is in a crisis?

A

Get a baseline bilirubin, baseline reticulocyte county, baseline hemoglobin, and sickle cells on smear

80
Q

What are lab values that will always be altered in sickle cell patients?

A

elevated bilirubin, elevated LDH, low haptoglobin, elevated reticulocyte count

81
Q

Why should you avoid transfusions in sickle cell patients?

A

transfusions will lead to iron overload and then they will need deferoxamine to decrease the iron in their system.

82
Q

What two body parts can be destroyed in patients with sickle cell?

A
  • autoinfarction of the spleen

- avascular necrosis due to chronic vaso-occlusion

83
Q

If sickle cell patients develop osteomyelitis in chronically infarcted bones, what organisms would you suspect?

A
  • s. aureus

- salmonella

84
Q

What is the treatment for a sickle cell patient in an acute crisis?

A

IVF, oxygen, IV pain control

85
Q

What are the indications for acute transfusions in sickle cell patients?

A
  • encephalopathy
  • chest pain
  • noncardiogenic pulmonary edema
  • priapism
86
Q

Serum sickness is what type of hypersensitivity reaction? What is the physiologic cause?

A
  • Type III

- Antibody-antigen complex

87
Q

Give an example of a cytotoxic, antibody mediated reaction (Type II)?

A

Hemolytic Anemia

88
Q

What is the treatment for anaphylaxis?

A

epinephrine 1:1000 IM

89
Q

What is the clinical diagnosis of anaphylaxis?

A

symptoms involving more 2 or more organ systems including CV, GI, Skin, and Pulmonary.

90
Q

Skin reactions from contrast, opiates, and red man syndrome are due to?

A

mast cell degranulation

91
Q

What is the difference between urticaria and angioedema?

A

Angioedema involves deeper tissues

92
Q

What are the clinical exam findings of allergic rhinitis?

A
  • allergic shiners
  • allergic salute (transverse nasal crease)
  • pale and boggy nasal mucosa
  • cobble-stoning of the posterior pharynx
93
Q

what is the most effective treatment of allergic rhinitis?

A

intranasal GC’s

94
Q

What surfaces of a child would you find atopic dermatitis?

A

Infants: extensor surfaces
Children: flexor surfaces

95
Q

A 6 month old child presents to clinic due to vomiting and bloody stool. He has lost weight on his growth curve. Mom states he is not tolerating his feeds well. What is your differential diagnosis?

A

Milk-protein allergy

96
Q

Amblyopia is a defect where in the eye?

A

cortical blindness

97
Q

How do you fix strabismus?

A

patch the good eye to correct the offending eye

98
Q

Reflection of light from separate locations on each eye is known as?

A

strabismus

99
Q

A pure white retinal reflex coming from the posterior portion of the eye is likely?

A

retinoblastoma

100
Q

What future tumor are children with retinoblastoma at risk for?

A

osteoblastoma of the distal femur

101
Q

What is the major cause of cataracts in infants?

A

Think TORCH infection if born with it or galactosemia if it develops in early life.

102
Q

Why should high flow oxygen be used sparingly in premature neonates?

A

risk for retinopathy of prematurity

103
Q

What is the treatment for retinopathy of prematurity?

A

laser ablation

104
Q

erythromycin gel for the eyes of newborns is used to prevent?

A

gonococcal conjunctivitis

105
Q

In a neonate with chlamydial conjunctivitis should be evaluated for?

A

pneumonia

106
Q

What infectious conjunctivitis develops early in a neonate?

A

gonorrhea develops before chlamydia

107
Q

What is the first line treatment for AOM? What if the child has a PCN allergy?

A

Amoxicillin

Cefdinir or Azithromycin

108
Q

In a child with AOM with an anteriorly rotated ear, what should be done?

A

Surgery consult for acute mastoiditis

109
Q

What are the most common organisms in acute otitis externa?

A

S. aureus and pseudemonas

110
Q

When are antibiotics required for acute otitis externs?

A

if there is evidence of malignant otitis externa

111
Q

In a child with pharyngitis and conjunctivitis, the most common culprit is?

A

adenovirus

112
Q

In a child with pharyngitis and a rash on the palms and soles?

A

Coxsackie virus

113
Q

What are the Centor criteria for strep diagnosis?

A 
C-absent cough 
E-exudates on tonsils 
N-nodes (anterior chain)
T-Temp greater 38
OR-Less than 14 or greater than 44 years old

Must have 4 for treatment or 2-3 to do a rapid strep

114
Q

What age range in children should never be tested for strep throat?

A

Less than 3 years of age

115
Q

An infant who turns blue at rest, but pinks up with crying should be evaluated for?

A

choanal atresia

116
Q

The difference between simple and complex seizures is?

A

complex involves loss of consciousness

117
Q

A simple febrile seizure has these four characteristics?

A

generalized in origin, lasts less than 15 minutes, only one 2seizure in a 24 hour period, no underlying neurological problems

118
Q

An EEG in an infant without fever, which shows symmetrical spasm that shows high amplitude and irregular spikes and waves should be treated with?

A

ACTH for infantile spasm

119
Q

In a child with ash leaf spots, MR, angiofibromas of the face, and seizures should be evaluated with?

A

MRI to look for cortical tubers of tuberous sclerosis

Pediatrics (9 decks)

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