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Pediatrics > Well Child and neonatology > Flashcards

Well Child and neonatology Flashcards

1
Q

What is some routine health screening tests used for pediatric cases

A

Day one of life: Screen metabolic/genetic diseases

Well child visit: 2-4 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15, 18, 24 months, then annually

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2
Q

When should lead/anemia screening be done

A

At 9-15 months only in communities where 1/3rd of houses built before 1950s, then repeat at age 2

Age 9-15 months, age 2

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3
Q

When should screening for blood pressure begin

A

Age 3 and every visit after

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4
Q

When should vision and hearing be screened

A

At birth, then annually at age 3

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5
Q

What is the definition of failure to thrive

A
  1. Weight < 3rd-5th weight percentile
  2. Weight for height < 10th percentile
  3. Weight velocity crossing two major percentiles
  4. Height < 3rd percentile or height crossing two major percentiles
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6
Q

What is the differential for failure to thrive

A
  1. Inadequate intake: Secondary to psychosocial issues - MOST COMMON
  2. Inadequate absorption
  3. Increased metabolic demand
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7
Q

What is the treatment for failure to thrive

A
  1. If no organic cause, start calorie count
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8
Q

What are important gross motor development milestones to remember

A 
4 months: Rolls front to back/back to front
6 months: Sits unassisted
9 months: Pulls to stand
12 months: Walks alone
15 months: Walks backwards
2 years: Down steps with help and jumps
3 years: Tricycle
4 years: Hopping
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9
Q

What are important fine motor development milestones to remember

A 
6 months: Transfers objects
9 months: Three finger grasp
12 months: Two finger grasp
2 years: Builds tower of 6 cubes
3 years: copies circle
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10
Q

What are important language skills in milestones

A 
9 months: Says mama/dada non-specifically
12 months: Says mama/dada specifically
15 months: 4-6 words
2 years: 200 words, two word phrases
3 years: three word phrases
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11
Q

What are important social/cognitive skills in development milestones

A

6 months: Stranger anxiety

15 months: Temper tantrum

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12
Q

Safety: How should car seats be placed in the car and what is the timeframe for removing them

A

Place in rear seat, rear facing

Remove when

  1. Child > 20lbs
  2. Child > 1yr of age
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13
Q

What should you do when a child presents with an abnormal fracture of a bone

A

Do a full work up for any other cause of abnormal fractures: Order full assort of labs

Order skeletal survey, head CT, and opthalmological exam

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14
Q

How should infants sleep

A

Sleep on their backs to avoid SIDS

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15
Q

What is the definition of colic in a child

A

Severe paroxysmal crying > 3 hours a day, 3 days a week, for three weeks in healthy well fed child that peaks 6 weeks of life, and regresses 3-4 months

Treatment: Reassurance

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16
Q

What is the definition of neonatology

A

Younger than 28 years old, from birth to ready to be discharged

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17
Q

What are four neonatal respiratory diseases that I should know

A
  1. Respiratory distress syndrome
  2. Transient tachypnea of the newborn
  3. Meconium aspiration syndrome
  4. Congenital diaphragmatic hernia
18
Q

What is respiratory distress syndrome, its diagnosis, and treatment

A

Surfactant deficiency: Poor lung compliance

Occurs in premature infants

Exam: CXR shows decreased air movements, ground glass appearance

Treatment: Prevention by antenatal steroids for mother, and surfactant administration at time of delivery

19
Q

What is transient tachypnea of the newborn

A

Retained fetal lung fluid, resolves completely

Usually happens in short labor or C-section

Exam: CXR shows perihilar streaking and fluid in interlobar fissures

Treatment: Mild to moderate O2 for support

20
Q

What is meconium aspiration syndrome

A

Aspiration pneumonitis caused by aspiration at or near birth

Exam: Hypoxia with CXR showing lobar consolidation

Treatment: Nasopharyngeal suctioning and tracheal suctioning, ventilator support and antibiotics

21
Q

What is congenital diaphragmatic hernia

A

Defect in diaphragm, herniation of abdominal contents into cavity, causing pulmonary hypoplasia

Presents with severe respiratory distress at birth, CXR shows bowel loops in chest

Treatment: Immediate intubation, and surgical correction after stabilization

This is dangerous out of the four

22
Q

When should someone be worked up for neonatal sepsis

A

If the temperature if 38 degrees Celsius in someone < 2mo old, that warrants full sepsis workup including CBC, blood cultures, UA, urine culture, and an LP and given IV antibiotics for minimum of 48 hours

Common pathogens: E. Coli, GBS, gram negative rods

23
Q

What is the treatment for neonatal sepsis

A

IV ampicillin (covers listeria) + gentamicin or third generation cephalosporin (ceftriaxone contraindicated in infants < 28 days old)

24
Q

What are the TORCHES infections

A
  1. Toxoplasmosis
  2. Other
  3. Rubella
  4. Cytomegalovirus
  5. Herpes
  6. Syphilis
25
Q

What is toxoplasmosis infection

A

Vertical transmission from mother to child, pressentes with hydrocephalus, seizures, chorioretinitis, ring enhancing lesions on CT

Treatment: Pyrimethamine, sulfadiazine, spiramycin

Prevention: Avoid cats/cat feces during pregnancies, and avoid raw/undercooked meat during pregnancy

If mother has active infection during pregnancy, mother must be treated during pregnancy

26
Q

What is rubella infection in child

A

Will present with blueberry rash, cataracts, hearing loss, and possible PDA heart defect

Prevention: Immunize mothers prior to pregnancy

No treatment

27
Q

What is cytomegalovirus infection in children

A

Petechial rash, periventricular calficiations, chorioretinitis

Treatment: Ganciclovir

Prevention: None

28
Q

What is herpes simplex virus infection

A

Presents with skin, eye, nad mouth vesicles

Treatment: Acyclovir

Prevention: Perform C-section if mother has active lesions at delivery (remember that C-section can be done in HIV for some reason)

29
Q

How to prevent syphilis in child

A

Treat seropositive mothers with penicillin

30
Q

What is cleft lip/palate in a child, and when do you repair

A

Abnormal ridge/division that presents at birth, associated with poor feeding and recurrent otitis media

Treatment: Surgical repair

31
Q

What are abdominal wall defects that are commonly seen in neonates

A
  1. Gastroschises - intestine protrudes through defect
  2. Omphalocele - membrane covered herniation of abdominal contents

Associated abnormalities with omphalocele

Treatment: Cover it with sterile dressing, NG decompressions, antibiotics, stabilization followed by staged closure

32
Q

How would a baby with intestinal atresia present

A

Abdominal distension with bilious vomiting, failure to pass meconium

In down syndrome, look for characteristic double bubble sign of duodenal atresia

Treatment: Surgical resection

33
Q

How would a baby with hirschsprung disease present

A

Absence of ganglion cells in colon leading to narrowing of aganglionic segment with dilation of proximal normal colon

Presents with failure to pass meconium, vomiting, abdominal distension

Diagnosis: Rectal biopsy at anal verge to look for ganglion cells

34
Q

What is the treatment for hirschsprung disease

A

Staged procedure with initial diverting colostomy followed by resection with infant > 6 mo age

35
Q

What are neural tube defects

A
  1. Anencephaly - incompatible with life
  2. Spina bifida - Myelomeningocele, meningocele

Signs/symptoms: Many kinds of defects, related to increased risk of latex allergy

Prevention: Decrease risk with folate ingestion during first trimester

36
Q

What are the different kinds of jaundice that can present

A
  1. Physiologic jaundice: INDIRECT hyperbilirubinemia
  2. Breast milk jaundice
  3. Pathologic jaundice
37
Q

When is jaundice less likely to be phsyiologic

A
  1. Within first 24 hours
  2. If direct bilirubin is elevated
  3. Indirect bili really high - above 30 can cross into brain and cause kernicterus by depositing in basal ganglia
38
Q

What is the presentation and treatment for physiologic jaundice

A

Indirect bilirubin starts rising 36-48 hours after birth, peaks 10-15 at 5-7 days

  1. Increase feeding
  2. Second line - UV phototherapy
  3. Third line - Exchange transfusion
39
Q

What is breast milk jaundice

A

Breast milk that contains enzyme to further delay hepatic bilirubin conjugation

Symptoms: Jaundice first 3-5 days, peaks at 2 weeks, reaches 19-20, and lasts two months

Treatment: None, continue breast feeding

40
Q

What are the symptoms of kernicterus in pathologic jaundice

A

High levels of indirect hyperbilirubinemia with jaundice, lethargy, poor feeding, high pitched cry, hypertonicity, and seizures

41
Q

What Is the treatment for pathologic jaundice

A

Phototherapy and exchange transfusion

Pediatrics (5 decks)

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