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Pediatrics AQ cases > 7 > Flashcards

7 Flashcards

1
Q

Baby is acrocyanotic, has HR 120, grimace, regular respirations, good activity, and is resisting extension of muscles. What is score

A

9 (1 off for acrocyanosis)

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2
Q

What does APGARs stand for?

A 
Appearance
Pulse
Grimace
Activity
Respirations
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3
Q

What pulse in APGARS is normal?

A

> 100

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4
Q

What is normal for respirations in APGARS?

A

Regular

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5
Q

Newborn s/p c-section with grunting and chest xr that shows hyperextended and wet lungs. What is likely cause?

A

TTN; self-limited, resolved by 48 hours; may need to provide PPV

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6
Q

35 week old with little air movement and increased respiratory effort. CXR shows hypoinflated lungs and atelectasis. What is going on and what to do?

A

RDS, give surfactant (ideally give corticosteroids to mom prenatally when premature)

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7
Q

Which babies are screened for hypoglycemia?

A

Abnormally sized (LGA, SGA, IUGR) and IDA (infants of diabetic mothers)

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8
Q

What is retinopathy of prematurity?

A

Neoangiogenesis due to oxygen requirement, can lead to retinal detachment or blindness; tx with laser ablation

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9
Q

Premature baby with bulging fontanelles. What dx is important to considers in premature babies, especially < 34 weeks

A

IVH, vascularity of ventricles highly susceptible to bp changes before involution at 34; dx with cranial doppler

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10
Q

Neonate with bloody stools and air in bowel (pneumatosis intestinalis) on XR. What is it?

A

Necrotizing Fascitis of Bowels

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11
Q

When can you say “failure to pass meconium”

A

Nothing after 48 hours

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12
Q

What’s on your ddx for failure to pass meconium?

A

meconium ileus, imperforate anus, hirschsprungs

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13
Q

What to consider in neonate with imperforate anus

A

VACTERL deformities (vertebral, anus, cardiac, trachea, esophagus, renal, limb)

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14
Q

Newborn fails to pass meconium. Did not have newborn screen. Likely diagnosis?

A

Meconium ileus due to CF. Remove with enema. Confirm dx with sweat chloride test.

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15
Q

What’s the path behind hirschprung disease?

A

Failure of migration of inhibitory auerbach/meissner plexus

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16
Q

A neonate has failure to pass meconium. On examination, a finger is placed in anus and there is explosive diarrhea. What is likely diagnosis?

A

Hirschsprung disease. Finger released block.

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17
Q

You suspect a child with FTPM has hirschsprung. What to do to diagnosis?

A

XR followed by imaging with contrast enema. Helps identify bad colon -> then biopsy and eventually surgically remove

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18
Q

Polyhydraminos, downs syndrome, bilious emesis. What is it?

A

Duodenal atresia; XR will show double bubble PLUS no gas beyond; tx is surgery

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19
Q

What is an annular pancreas?

A

Failure of pancreas apoptosis; effectively same as duodenal atresia (surgery will give you answer); primary problem of genetics (Downs associated)

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20
Q

What are four causes of bilious emesis?

A

Malrotation, duodenal atresia, annular pancreas, intestinal atresia

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21
Q

What two causes of bilious emesis are associated with Downs?

A

Duodenal atresia and annular pancreas

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22
Q

Newborn in hospital has non-biliious emesis, gurgling and bubbling. What should be done to diagnose?

A

NG tube with XR. Does it get to stomach or does it coil up indicating TE fistula; must provide parenteral nutrition until corrected surgically

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23
Q

When does pyloric stenosis manifest?

A

2-8 weeks

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24
Q

2 causes of non-bilious vomiting?

A

TE fistula, pyloric stenosis

25
Q

4 week old, non-bilious projectile vomiting, olive-shaped mass, visual peristaltic wave. What to do?

A

Pyloric stenosis; US will show donut sign; Get labs; tx with pyloromyotomoy

26
Q

A child has pyloric stenosis. What to do before surgery?

A

Make sure labs are good. If low Cl and K and metabolic alkalosis, give fluids and correct.

27
Q

Four things to assess vomiting

A

How old is baby
Other defects/Downs
Color - bilious or not?
Projectile?

28
Q

DDx for Conjugated/Direct Hyperbilirubinemia

A

Biliary Atresia
Sepsis
Metabolic Derangements

29
Q

2 causes of unconjugated hyperbilirubinema

A

Hemolytic, hemorrhagic

30
Q

Can conjugated/direct bili cross BBB?

A

NO, trapped in urine and will be excreted

31
Q

Is unconjugated/indirect bili fat soluble?

A

YES, can cross BBB and cause kernicterus

32
Q

Why does unconjugated hyperbili in first week of life called “physiologic jaundice”?

A

As a result of overwhelming the system, limited capacity of liver to conjugate. Watch it, expect to resolve by 1 weeks

33
Q

Is conjugated hyperbili pathologic?

A

YES

34
Q

Scaphoid abdomen, bowel sounds in lung fields, minimal breath sounds

A

Diaphragmatic hernia

35
Q

Baby is born with intestines protruding into umbilical cord, protected by peritoneal layer. What is it?

A

Omphalocele - will be midline and bulging, looks like an O

36
Q

Baby is one week old with jaundice, and labs show direct hyperbili. You suspect biliary atresia. What to do?

A

US first. If no duct, give phenobarbitol (stimulates bile production) and f/u with HIDA scan; tx is surgery

37
Q

What serum marker in antenatal screen indicates neural tube defect?

A

AFP, will be increased

38
Q

Newborn has out-pouching of lower back with just CSF. What is it?

A

Meningocele

39
Q

What is in the out-pouching of myelomeningocele?

A

CSF and nerves

40
Q

In FTT, which growth curve will change last?

A

Head circumference

41
Q

When should a kid be able to ride tricylce?

A

3 yrs

42
Q

When should stranger danger develop?

A

6 mo

43
Q

When should a child be able to hop?

A

4 years

44
Q

What is risk to pregnant mom when her toddler has parvovirus?

A

Hydrops

45
Q

What is German Measles?

A

Rubella

46
Q

Rash that starts at face and moves down

A

Measles and Rubella

47
Q

Measles prodrome

A

Cough, coryza, conjunctivitis, koplik spots

48
Q

What is potential future complication of measles

A

Subacute Sclerosing Pan Encaphilitis

49
Q

Since mealses and rubella rash can appear similarly, how to differentiate?

A

Rubella = generalized and tender lymphadenopathy

50
Q

Roseola prodrome

A

high-spiking fever (like 104), once fever breaks THEN rash develops

51
Q

Is the rash of roseola exact opposite that of measles and rubella?

A

YES; roseola starts on trunk and THEN goes out to extremities and head

52
Q

what NOT to use for fever mgmt in virus?

A

Aspirin - causes Reye syndrome

53
Q

What do we call varicella in a kid?

A

chicken pox

54
Q

Varicella in an adult?

A

Shingles

55
Q

Unvaccinated pubertal male with parotid swelling and orchitis

A

mumps

56
Q

What’s a potential complication of mumps?

A

infertility

57
Q

What bug is responsible for hand foot mouth disease?

A

Coxackie A

58
Q

What can be used to shorten duration of shingle outbreak?

A

Acyclovir

Pediatrics AQ cases (13 decks)

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